REHABILITATION PROTOCOL:TOTAL SHOULDER REPLACEMENT

Phase I (Weeks 0-6)

• Sling immobilization for first 4-6 weeks – out of sling to do home exercise program (pendulums) twice daily

• Range of Motion - PROM🡪AAROM🡪AROM as tolerated except No Active Internal Rotation/Backwards extension for 6 weeks (Protect Subscapularis Repair)

• Week 1 Goal: 90° Forward Flexion, 20° External Rotation at the Side, Maximum 75° Abduction

• Week 2 Goal: 120° Forward Flexion, 40° External Rotation at the Side, Maximum 75° Abduction

• Therapeutic Exercise

• Grip Strengthening

• Pulleys/Cane

• Elbow/Wrist/Hand Exercises

• Teach Home Exercises - Pendulums

• Heat/Ice before and after PT sessions

Phase II (Weeks 6-12)

• Discontinue sling if still being worn

• Range of Motion – AAROM/AROM – increase as tolerated with gentle passive stretching at end ranges

• Begin Active Internal Rotation and Backward Extension as tolerated

• Therapeutic Exercise

• Begin light resisted exercises for Forward Flexion, External Rotation and Abduction – isometrics and bands – Concentric Motions Only

• No Resisted Internal Rotation, Backward Extension or Scapular Retraction

• Modalities per PT discretion

Phase III (Months 3-12)

• Range of Motion – Progress to full AROM without discomfort

• Therapeutic Exercise

• Begin resisted Internal Rotation and Backward Extension exercises

• Advance strengthening as tolerated – Rotator Cuff, Deltoid and Scapular Stabilizers

• Begin eccentric motions, plyometrics and closed chain exercises

• Modalities per PT discretion