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/Backward 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.
3. Modalities per PT discretion.