Shoulder Arthroplasty

Phase 1: Hospital to 1^st Follow up – Protect Subscapularis (0 to 2 weeks)

• Patients may shower immediately over clear plastic, waterproof dressing
• Waterproof (tegaderm) dressing will be removed by surgeon at 1^stpost-op visit
• Sutures are all underneath the skin and will dissolve on their own
• Sling should be worn at all times with the exception of showering and while performing shoulder exercises
• While lying supine, the distal humerus/elbow should be supported by a pillow or towel roll to avoid shoulder extension
• Therapist should teach the following in hospital on POD1 to be performed 3 times per day starting immediately:
  • Elbow, forearm, and hand AROM
  • Supine passive ROM – flexion to 130, ER to 20 – See Handout

    Supine exercises should be performed with a small towel placed behind the elbow to avoid shoulder hyperextension and anterior capsular stretch

  • Emphasize home program

Phase 2: Protect the Subscapularis(2 to 6 weeks)

• Sling should be worn at night and when out of house. May remove the sling during the day with the following restrictions:
  • Limit ER to 20
  • No resisted IR
  • Avoid extension of shoulder
  • Avoid reaching behind the back
  • Do not lift anything greater than 2 to 3 lbs with the involved hand
  • While lying supine, the distal humerus/elbow should be supported by a pillow or towel roll to avoid shoulder extension
• Continue Phase 1 exercises with the addition of:
  • Pendulums
  • AAROM - Pulleys into scapular plane elevation to 130, ER to 20
  • Supine AAROM into flexion and ER with above limits
  • Emphasize home program

Phase 3: (6 weeks -10 weeks)

• Discontinue sling use
• Lifting restriction of 10 pounds remains
• Advance AROM and PROM as tolerated
  • Maintain ER limit of 30 until 10 weeks.
  • Advance elevation as tolerated
• Scapular stabilizer strengthening.
• Strengthen rotator cuff and shoulder musculature (Isometrics, Theraband, dumbbell, etc).  AVOID RESISTED IR OR EXTENSION UNTIL 10 WEEKS.

Phase 4: (>10 weeks)

• Advance shoulder ER range of motion as tolerated (Light stretching only).
• May initiate subscapularis strengthening (resisted IR and extension).
• Advance shoulder and rotator cuff strengthening as tolerated.
• Incorporate low level functional activities at 3 months (swimming, water aerobics, light tennis, jogging)
• Start higher-level activities at 4 months (tennis, light weight training, and golf).
• Initiate functional progression to sports specific activities at 4 months.

Reverse Shoulder Arthroplasty for Chronic Dislocation

Phase I: Protect the Repair (0 to 6 weeks)

• Staples to be removed at 14 days after surgery
• Sling/immobilizer should be worn AT ALL TIMES other than when showering
• Initiate exercise program 3 times per day immediately:
• Immediate elbow, forearm and hand AROM
• Pendulums may begin at 2 weeks after instruction by therapist
• Passive Supine ROM to 90 degrees FE and 20 degrees ER.

Phase II: PROM/AAROM (6 to 8 weeks)

• Discontinue sling at all times
• Lifting restriction of 2-3 pounds
• Advance AAROM and PROM as tolerated
• Maintain ER limit of 30 until 8 weeks.
• Advance forward elevation as tolerated
• Scapular stabilizer strengthening.

Phase III: AROM/Strengthening (>8 weeks)

• Advance AROM as tolerated
• Strengthen rotator cuff and shoulder musculature (Isometrics, Theraband, dumbbell, etc).  AVOID RESISTED IR OR EXTENSION UNTIL 10 WEEKS.
• Lifting restriction of 10 pounds until 3 months
• Incorporate low level functional activities at 3 months (swimming, water aerobics, light tennis, jogging)
• Start higher level activities at 4 months (tennis, light weight training, and golf).
• Initiate functional progression to sports specific activities at 4 months.

Reverse Shoulder Arthroplasty for Fracture

Phase I: Protect the Tuberosity (Rotator Cuff) Repair (0 to 6 weeks)

• Staples to be removed at 14 days after surgery
• Sling/immobilizer should be worn AT ALL TIMES other than when showering
• Initiate exercise program 3 times per day immediately:
• Immediate elbow, forearm and hand AROM
• Pendulums may begin at 2 weeks after instruction by therapist

Phase II: PROM/AAROM (6 to 8 weeks)

• Discontinue sling at all times
• Lifting restriction of 2-3 pounds
• Advance AAROM and PROM as tolerated
• Maintain ER limit of 30 until 8 weeks.
• Advance forward elevation as tolerated
• Scapular stabilizer strengthening.

Phase III: AROM/Strengthening (>8 weeks)

• Advance AROM as tolerated
• Strengthen rotator cuff and shoulder musculature (Isometrics, Theraband, dumbbell, etc).  AVOID RESISTED IR OR EXTENSION UNTIL 10 WEEKS.
• Lifting restriction of 10 pounds until 3 months
• Incorporate low level functional activities at 3 months (swimming, water aerobics, light tennis, jogging)
• Start higher level activities at 4 months (tennis, light weight training, and golf).
• Initiate functional progression to sports specific activities at 4 months.

Revision Shoulder Hemiarthroplasty

Phase I: Protect the Replacement (0 to 10 weeks)

• Sling/immobilizer should be worn AT ALL TIMES for 6 weeks then when sleeping and out in public
• Initiate exercise program 3 times per day immediately:
  • Immediate elbow, forearm and hand AROM
• Pendulums may begin at 2 weeks after instruction by therapist
• At 6 weeks begin PASSIVE supine ROM to 130 FE and 30 ER

Phase II: PROM/AAROM (10-12 weeks)

• Discontinue sling at all times
• Lifting restriction of 2-3 pounds
• Advance AAROM and PROM as tolerated
  • Maintain ER limit of 30 until 8 weeks.
    Advance forward elevation as tolerated
• Scapular stabilizer strengthening.

Phase III: AROM/Strengthening (> 12 weeks)

• Advance AROM as tolerated
• Strengthen rotator cuff and shoulder musculature (Isometrics, Theraband, dumbbell, etc). AVOID RESISTED IR OR EXTENSION UNTIL 10 WEEKS.
• Lifting restriction of 10 pounds until 3 months
• Incorporate low level functional activities at 3 months (swimming, water aerobics, light tennis, jogging)
• Start higher level activities at 4 months (tennis, light weight training, and golf).
• Initiate functional progression to sports specific activities at 4 months.

Supine Passive ROM

Three to 5 times each day you should perform supine passive forward elevation and external rotation (outward turning) exercises with the operative arm. Both exercises should be done with the non-operative arm used as the "therapist arm" while the operative arm remains completely relaxed. Ten of each exercise should be done three to five times each day.

Overhead reach is helping to lift your stiff arm up as high as it will go. To stretch your overhead reach, lie flat on your back, relax, and grasp the wrist of the tight shoulder with your opposite hand. Using the power in your opposite arm, bring the stiff arm up as far as it is comfortable. Start holding it for ten seconds and then work up to where you can hold it for a count of 30. Breathe slowly and deeply while the arm is moved. Repeat this stretch ten times, trying to help the arm up a little higher each time.

External rotation is turning the arm out to the side while your elbow stays close to your body. External rotation is best stretched while you are lying on your back. Hold a cane, yardstick, broom handle, or dowel in both hands. Bend both elbows to a right angle. Use steady, gentle force from your normal arm to rotate the hand of the stiff shoulder out away from your body. Continue the rotation as far as it will go comfortably, holding it there for a count of 10. Repeat this exercise ten times.

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