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Total shoulder replacement post-operative physical therapy protocol

General Considerations:

  • Use of a sling for 3 weeks post-op unless otherwise indicated.
  • No pulley in the first 6 weeks.
  • No resistance until 4 ½ months, periscapular strengthening ok.
  • Minimize heavy, excessive cyclic loads for the first 6 months.
  • Maintenance of good postural positioning when performing all exercises.
  • Maintain surgical motion early, but protect subscapularis repair by avoiding internal rotation strengthening for the first 4 months.
  • Aerobic conditioning throughout the rehabilitation process with pool and land therapy.
  • All active exercises should be carefully monitored to minimize substitution or compensation.
  • M.D. follow-ups Day 1, 4 weeks, 3 months, 6 months and 1 year.

Week 1

  • Nurse visit day 2 to change dressings and review home exercise program with PT.

Manual

  • Soft tissue mobilization to surrounding tissues, effleurage for edema.
  • Passive range of motion into flexion and external rotation as tolerated to neutral ranges. A/PROM for hand and elbow.

Exercises

  • Pendulums, towel slides, elbow flexion and extension, wrist and forearm strengthening. Patient PROM
  • Cervical stretches, scapular squeezes, lower trap squeezes.
  • It is important to come out of the sling to bend and straighten elbow for 10-15 repetitions each time to minimize arm and hand swelling
  • Well-body cardiovascular exercise (stationary bike, elliptical without arms, stairmaster).

Goals

  • Decrease pain and edema. Continue sling use.
  • Passive range of motion flexion to 90 degrees, external rotation to neutral.

Weeks 2 - 4

  • Nurse visit for stitch removal at Day 14.

Manual

  • Continue soft tissue treatments, passive range of motion, scapula glides, light joint mobilizations as tolerated, nerve glides as needed -Pain control (i.e. cryotherapy, massage, electric stimulation).

Exercises

  • Begin isometrics in all planes
  • Begin pool exercises for water assisted exercises as tolerated.
  • Scapular strength training exercises with theraband.
  • General conditioning as tolerated (include trunk flexion & extension exercises).

Goals

  • Decrease pain and edema. Continue sling use, but begin weaning from sling to night and out of house as needed at 3 weeks.
  • Passive range of motion flexion, abduction, internal rotation to 90 degrees.
  • Active assisted range of motion flexion, abduction to 90 degrees with good mechanics.

Weeks 4 - 6

  • MD visit for one month post surgery.

Manual

  • Continue as needed for soft tissue, fascial, and joint mobility, nerve glides as necessary.

Exercises

  • Progress scapular strengthening into further protraction-retraction.

Goals

  • Continue weaning from sling with slow progression toward normal ADLs.
  • Full passive range of motion.

Weeks 6-12

  • MD visit for 3 month post surgery.

Manual

  • Continue as needed for soft tissue, fascial, and joint mobility.

Exercises

  • Begin strengthening against gravity in straight planes with AAROM and AROM from supine, seated to standing. No combined motions. Pulley ok. Start external rotation exercises (minimize reps 5-10).

Goals

  • Discontinue sling use.

Weeks 12+

Progress to combined movements and

  • Initiate sport specific training as tolerated with no pain.
  • Continue strengthening, endurance training, and overall fitness.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.

 

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