Surgical Explanations
Rehabilitation Protocols
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Total Shoulder Replacement
Rehabilitation of a total shoulder replacement requires careful communication with the referral source.
CONSIDERATIONS:
Medical status
Osteoporosis
Integrity of rotator cuff
Reason for shoulder replacement
Pre-surgical range of motion and functional levels
Adjunctive procedures: torn subscapularis, etc.
Past medical history: anti-inflammatory use, pain medicine use, history of previous corticosteroid use
Age
PHASE 1: 0-2 WEEKS
EXERCISES:
Pendulum Passive ROM in all planes w/ rotation with shoulder in neutral position
Shoulder shrugs, pinches
If any subscapularis repair/removal was performed, must be very cautious with ER
NO AROM
PHASE 2: 3 WEEKS
EXERCISES:
Gentle isometrics in all planes except IR if subscapularis
PHASE 3: 4 WEEKS
EXERCISES:
Active assist w/ wand, cane, pulley in all planes
PHASE 4: 6 WEEKS
EXERCISES:
Discontinue sling
General active ROM as tolerated and continue with active assisted ROM and passive ROM
Theraband and shrug rolls
UBE—arm bike (upper body ergometer)
Wall climbs, IR stretches with towel
ER stretches in doorway
PHASE 5: 8 WEEKS
GOALS OF PHASE:
Looking for 70° IR supine and 140° flexion, 60° ER in scapular plane
If no full ROM, must pursue aggressive stretching program
EXERCISES:
Light dumbbell work for rotator cuff
Scaption, sideline ER, prone abduction
Chair push-ups, wall push-ups, single arm rows, diagonals with tubing
Bicep curls
Posterior capsule stretches, sideline into IR
PHASE 6: 4 MONTHS
GOALS OF PHASE:
Full strength in all planes
Full ROM |
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