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.
- 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.
Eight to Twelve Weeks Postop
- Return to full range of motion.
- Maximize function.