Total Shoulder Replacement Rehab Protocol

Keys to a Successful Outcome

  • 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. 

  • Never over-stress the anterior shoulder/capsule.

  • 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.

  • 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