Total Shoulder Replacement Rehab Protocol
Keys to a Successful Outcome
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Early protection of the subscapularis is essential to its integrity. This is the main reason 4–6 weeks of bracing is required and AROM and strength exercises are delayed until 6 weeks from surgery.
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Never over-stress the anterior shoulder/capsule.
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While lying supine for the first 6 weeks, a small pillow or towel roll should be placed behind the elbow to avoid shoulder hyperextension / anterior capsule stretch / subscapularis stretch.
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Forceful stretching and mobilization/manipulation is NEVER indicated at any phase of therapy.
Phase | Brace | ROM | WB | Exercises |
|---|---|---|---|---|
In Hospital | Worn at all times* | PROM only | NWB | Passive FF while supine; gentle ER in scapular plane (documented in Op Note), passive IR to chest, pendulum okay if comfortable |
Weeks 0-6 | Worn at all times* | PROM only | NWB | Elbow/wrist AROM, grip strength, scapular isometrics, no resistance exercises, PROM goals; FF 90°, ER 45°, IR 90°(measured at 30° abduction) |
Weeks 6-12 | Used for sleeping** | Begin AAROM -> AROM as tolerated | 1lb | Begin AROM in scapular plane; AAROM pulleys, pain-free isometrics in neutral, scapular strengthening, assisted horizontal add; PROM goals: FF 140, ER 60, IR 70; active FF to 100 |
Weeks 12-16 | None | Progress AROM/PROM as appropiate | 5lb | Assisted IR behind back stretch, resisted IR/ER in scapular plane, begin active elevation strengthening (i.e. Therabands); AROM goals: FF 140 (scapular plane supine), ER 60/IR 70 |
Months 4-6 | None | FAROM | 10lb | Gradually progress strengthening, return to light recreational hobbies (gardening, light sport activities) |
Months 6-12 | None | FAROM | 15lb | Avoid exercise and functional activities that put stress on the anterior capsule (i.e. combined ER and ABD) |
*Worn day and night; off for therapy/hygiene
**Used for sleeping only from weeks 6-8 and removed gradually during the day