Total Shoulder Replacement [Shoulder]

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.

– Strengthen the surrounding musculature.

– 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

Outpatient Rehab Phase I 0-3 weeks post op


o On except for:

 Exercises

 Dressing

 Eating

 Shower: Most have subcuticular closure with glue and may shower immediately.

– PROM (Performed by Therapist, not to exceed surgical rom)

o FLEX, ER to neutral – minimize reps (5-10)

o Therapist PROM should NOT be excessively painful. If it is STOP

o Encourage Patient PROM

– Pendulums and Codman’s ex’s

– Towel Slides or equivalent

– Pool for PROM.

– General conditioning (stationary bike, treadmill, etc)

– Maintain hand strength

– Maintain normal motion at the elbow/wrist

– Maximum ER to Neutral

3-6 weeks post op.


o Wean

o Wear at night and when out of house

o Don’t use arm to push up out of chair

– Supine AAROM (not to exceed surgical rom)

o FLEX, ABD, ADD, IR with towel, start ER at 6 weeks (minimize reps 5-10).

– Pool for PROM and AAROM (water is the assistance)

o Use combined motions and teach fluidity of movement.

o 10 reps with combined movements 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

Phase II 6-12 weeks

– Discontinue sling

– Continue with PROM.

– More AAROM on land

o 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


– Can begin pulley work and NOT BEFORE.

– Progress to some light closed-chain proprioceptive ex’s (wall washing)

– Arm bike with no resistance.

– Gentle jt mobes to restore normal accessory glide motion in shldr girdle if necessary.

Phase III 12-18 weeks post op

– Can begin AROM with COMBINED MOTIONS at 3 months (on land, against gravity).

– Begin light strengthening o Begin strengthening for lats, rhomboids, biceps/triceps, pecs, and deltoids.

– Pool – continue

o Use floats and paddles for resistive work in the pool.

– Increase scapular strengthening with theraband and light weights.

– Add more advanced proprioceptive ex specific for work, ADL’s and sport.