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.