Total Shoulder Replacement Post-Op Protocol

PHASE I (0-6 WEEKS)

*Sling used

Restrictions:

• Week 1
  • 120° FLEX
  • 20° ER
  • 75° ABD
• Week 2
  • 140° FLEX
  • 40° ER
  • 75° ABD
  • NO active IR, EXT

ROM:

• Codman/pendulum exercises
• PROM to limit
• Capsular stretches: ANT, POST, INF
• AAROM: FLEX, EXT IR, ER
• Progress to AROM as tolerated

Strengthening: Grip strength only

Criteria to progress to phase II:

• Minimal pain and tenderness
• Almost full ROM
• Intact subscapularis w/o evidence of tendon pain on resisted IR

PHASE II (6-12 WEEKS):

Restrictions:

• Increase ROM goals:
  • 160° FLEX
  • 60° ER
  • 90° ABD

ROM:

• Goals as above
• Increase AROM in all directions
• Passive stretching
• Joint mobilizations for capsular restrictions

Strengthening:

• RTC strengthening 3x/wk to prevent RTC tendonitis
  • Closed chain isometrics
    • ER
    • ABD
  • Progress to open-chain with theraband
    • Concentric: ER, ABD, FLEX
    • Eccentric: ER, ABD, FLEX
  • Isotonic dumbbell exercises
    • ER, ABD, FLEX
  • Scapular stabilizer strengthening
    • Scapular retraction/protraction
    • Scapular Depression & shrugs

PHASE III (3-12 MONTHS):

ROM:

• ROM equal to opposite side
• Utilize both AROM & PROM exercises to maintain motion

Strengthening:

• Begin IR & EXT strengthening
• Scapular stabilizing strengthening
• Deltoid strengthening
• Plyometric exercises

References:
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd ed. Philadelphia, PA: The Curtis Center; 2003.

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