Acute Phase (0- 4 weeks):

Precautions:
  • Avoid resisted range of motion internal rotation for 6 weeks.
  • For anatomic Total Shoulder Replacement avoid external rotation greater than 45 degrees for 4 weeks.
  • For Reverse Total Shoulder Replacement avoid external rotation greater than 30 degrees for 4 weeks.
  • No abduction greater than 90 degrees for 4 weeks.
  • Continue use of sling until physician states otherwise.
Therapeutic Exercises:
  • Neck flexibility.
  • Elbow and forearm active range of motion, progress to resistive range of motion to tolerance.
  • Pulleys forward flexion to tolerance, scaption less than 90 degrees.
  • Pendulum exercises.
  • Self-assist table slides into forward flexion/abduction.
  • Progress to cane rocking into forward flexion and scaption, cane external rotation within restrictions, cane internal rotation.
  • Isometric scapular retractions, depression.
  • Passive range of motion with therapist within precautions.

Four to Six Weeks Postop: Range of Motion Stage

  • Pulley active assisted range of motion forward flexion and scaption to tolerance achieving full range of motion.
  • T Bar/cane forward flexion, scaption/external rotation to tolerance at 45 degrees abduction, internal rotation, and extension.
  • Wall slides forward flexion/scaption.
  • Passive range of motion to tolerance.
  • Deep friction massage to scar.
  • Active range of motion, forward flexion, scaption, external rotation, extension, horizontal abduction, rows, and internal rotation. Start gravity lessened, progress to standing as tolerated, restore scapulohumeral rhythm.
  • Isotonic tubing: scapular retraction, depression.

Six to Eight Weeks Postop: Strengthening Phase

  • Advance external rotation range of motion to full available at 90 degrees abduction. *please note that for reverse total shoulder external rotation range of motion may be limited.
  • Passive range of motion, achieve 90 to 100 percent available range of motion.
  • Isotonic rowing, extension, LT pull-aparts, adduction, internal rotation,external rotation.
  • Rhythmic stabilization forward flexion, internal rotation, and external rotation.
  • UBE.

Eight to Twelve Weeks Postop

  • Return to full range of motion.
  • Maximize function.

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