Nathan WM. Skelley, M.D.

The goal of the rehabilitation process is to provide greater mobility to the patient than before the surgery. In addition, stability of the shoulder is vital and essential to normal non-painful shoulder function. The key to the success of the rehabilitation following total shoulder replacement is compliance to your exercise program.

Precautions: In hospital, use immobilizer.

Discontinue immobilizer at Day 1-3 and use sling for comfort for a few days
NO INTERNAL ROTATION for 6 weeks for RISK of disrupting subscapularis repair

 

PHASE ONE - IMMEDIATE MOTION PHASE (Week 0-4)

Goals: Allow early healing of capsule Increase passive range of motion

Decrease shoulder pain
Stop muscular atrophy and prevent RTC inhibition

WEEKS 1- 2

Sling for Comfort and Sleep (May discontinue sling as tolerated)

Exercises:
* Continuous Passive Motion (CPM) * Passive Range of Motion

a. Flexion (0-75 degrees)
b. ER (in scapular plane at 30 to 0 degrees
c. IR (in scapular plane at 30 degrees to 25-30 degrees

* Pendulum Exercises
* Elbow/Wrist ROM
* Gripping Exercise for Hand * Ice & Modalities
* Isometrics (Day 10)

a. Abductors
b. ER/IR
c. Elbow flexors

* Electrical Muscle Stimulation (if needed) * Rope and Pulley (POD 5-7) – Flexion

CAUTION: *****Do not stressfully actively internally rotate arm against resistance for possibility of pulling subscapularis repair for 4-6 weeks****

WEEKS 3-4

Sling as Needed

Continued

Exercises:
*Continue all ROM exercises

a. Initiate AAROM exercises
b. Progress flexion to 90-100 degrees
c. ER scapular plane at 45 to 25 degrees d. IR scapular plane at 45 degrees to side

*Initiate AAROM ER/IR supine with L-bar *Initiate rhythmic stabilization exercises

a. Flex/Ext

b. *Isometrics

a. b. c. d.

ER/IR in scapular plane

ER/IR Flex Ext Abd

*Rope and Pulley

 

PHASE TWO - ACTIVE MOTION PHASE (Week 4-12)

Goals: Improve dynamic stabilization and strength Improve Range of Motion

Decrease pain/inflammation Increase Functional Activities

WEEKS 5-8

Exercises:
* Active Assisted ROM Exercises with L-Bar (Begin week 2)

a. Flexion to tolerance
b. ER in scapular plane at 90 degrees abduction c. IR in scapular plane at 90 degrees abduction

* Rope and Pulley*All motions to tolerance

a. Flexion * Pendulum Exercises

* AROM Exercises
a. Supine Flexion if unable side-lying flexion

* Strengthening Exercises a. Tubing ER/IR

WEEKS 9-12

b. Rhythmic stabilization Flex/Ext and ER/IR c. Side-lying ER
d. Side-lying flexion
e. Scapular strengthening exercises

f. Prone rowing
g. Prone extensions
h. Biceps/triceps
i. Isometrics for deltoid

*Continue all exercises listed above *Prone goal:

Flexion 160 degrees
ER at 90 degrees Abd: 75-80 degrees IR at 90 degrees Abd: 60-65 degrees

*Continue to emphasize AROM and strength *Progress strengthening exercises
*Pool exercises and swimming

 

PHASE THREE - ACTIVITY PHASE (WEEKS 13-26)

*Initiation of this phase begins when patient exhibits:

1) PROM:
Flexion 0-160 degrees

ER 75 degrees

IR 60 degrees
2) Strength level 4/5 for ER/IR/ABD

Goals: Improve strength of shoulder musculature Neuromuscular control of shoulder complex Improve functional activities

Exercises*: AAROM and stretching exercises a. Flexion with L-bar

b. ER/IR at 90 degrees abduction *Strengthening exercises

a. ER/IR tubing
b. Full Can
c. Lateral raises
d. Prone rowing
e. Side-lying ER
f. Prone extension g. Biceps

h. Initiate interval sport program if appropriate (weeks 20-26)