Total Shoulder Replacement

Phase I (Weeks 0-6)

1. Sling immobilization for first 4-6 weeks–out of sling to do home exercise program (pendulums) twice daily.
2. 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.
3. Therapeutic Exercise:
   - Grip Strengthening.
   - Pulleys/Cane.
   - Elbow/Wrist/Hand Exercises.
   - Teach Home Exercises — Pendulums.
   
4. Heat/Ice before and after PT sessions.
   

 Phase II (Weeks 6-12)

1. Discontinue sling if still being worn.
2. Range of Motion –AAROM/AROM –  increase as tolerated with gentle passive stretching at end ranges.- Begin Active Internal Rotation and Backward Extension as tolerated.
3. 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.
4. Modalities per PT discretion.

 Phase III (Months 3-12)

1. Range of Motion – Progress to full AROM without discomfort.
2. 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.