Total shoulder replacement post-operative physical therapy protocol
- 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.
- Nurse visit day 2 to change dressings and review home exercise program with PT.
- 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.
- 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).
- 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.
- 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).
- 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).
- 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.
- Continue as needed for soft tissue, fascial, and joint mobility, nerve glides as necessary.
- Progress scapular strengthening into further protraction-retraction.
- Continue weaning from sling with slow progression toward normal ADLs.
- Full passive range of motion.
- MD visit for 3 month post surgery.
- Continue as needed for soft tissue, fascial, and joint mobility.
- 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).
- Discontinue sling use.
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.