Total Shoulder Arthroplasty Rehabilitation Protocol

PHASE I:

Week 0-3

Sling

  • All times except
    1. Exercise
    2. Dressing
    3. Eating
    4. Showering

ROM/Exercise

  • PROM performed by Physical Therapist (not to exceed surgical ROM)
  • FLEX and ER to neutral (minimize reps 5-10)
  • Therapist ROM should not be excessively painful.
  • Encourage patient PROM
  • Pendulums and Codman’s exercises
  • Towel slides or equivalent
  • Pool for PROM, once incision healed
  • General conditioning (stationary bike, treadmill, etc.)
  • Maintain hand strength
  • Maintain normal motion at the elbow and wrist
  • Do not use arm to push up out of chair/bed

Week 3-6

Sling

  • Wean
  • Wear at night and when out of house

ROM/Exercise

  • Supine AAROM (not to exceed surgical motion)
  • FLEX, ABD, ADD, IR with towel, start ER at 6 weeks (minimize reps 5-10)
  • Pool for PROM and AAROM (water is assistance)
  • Use combined motions and teach fluidity of movement
  • 10 reps with combined movement in pool
  • Light scapular strengthening (i.e. scapular setting, gentle MR scap protraction and retraction)
  • Gentle joint mobilization and soft tissue mobilization to restore normal scapular mobility
  • Nerve glides as necessary
  • Do not use arm to push up out of chair/bed

PHASE II:

Week 6-12

Sling

  • Discontinue sling

ROM/Exercise

  • Continue with PROM
  • Increase AAROM on land - Progress from SUPINE to SEATED, then to STANDING position
  • At 6 weeks begin AROM on land, against gravity (straight planes only, no combined motions)
  • Pool – continue AAROM and AROM
  • Can begin pulley work but NOT BEFORE
  • Progress to some light closed-chain proprioceptive exercises (wall washing)
  • Arm bike with no resistance
  • Gentle joint mobilization to restore normal accessory glide motion in shoulder girdle if necessary

PHASE III:

Week 12-18

Sling

  • None

ROM/Exercise

  • Begin AROM with combined motions at 12 weeks (on land, against gravity)
  • Begin light strengthening – lats, rhomboids, biceps, triceps, pecs, deltoids
  • Pool – continue and use floats and paddles for light resistive work in water
  • Increase scapular strengthening with theraband and light weights
  • Add more advanced proprioceptive exercises, specific for work, ADLs, sport

General Guidelines:

  • Maintain surgical motion early, but don’t push it.
  • Protect the subscapularis repair: No internal rotation resistance until at least 4 ½ months for patients with tenotomy.
  • For patients with Lesser Tuberosity (LT) osteotomy, internal rotation strengthening may progress as tolerated after 3 month post op checkup with x-ray to confirm LT healing.
  • Strengthen the surrounding musculature-this can start anytime.
  • Alternate between pool and land therapy.
  • Minimize heavy, excessive cyclic loads for the first 6 months.
  • No pulleys in first 6 weeks.
  • No resistance until 4 ½ months, except for periscapular muscles.

This is a gradual progression, not a stepped progression.

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