Total Shoulder Arthroplasty Rehabilitation Guidelines

Department of Rehabilitation Services 1 Total Shoulder Arthroplasty Rehabilitation Guidelines

Department of Rehabilitation Services

Indications: Total shoulder arthroplasty, or joint replacement, is indicated when pain, instability, or limitations in ROM interfere with a patient’s ability to perform functional tasks (Hand Rehabilitation Center of Indiana, 2001). Underlying diagnoses include rheumatoid arthritis, osteoarthritis, avascular necrosis trauma, or tumor.

Postoperative Rehabilitation:

Phase I: 0-3 Weeks Post-op

TREATMENT GOALS: 1. Patient education 2. Allow healing of subscapularis 3. Pain control 4. Initiate ROM exercises

POSTOPERATIVE DAY 1: . Patient education on precautions o Wear shoulder immobilizer/sling between exercises and at night for 4 weeks o Place a small pillow or towel roll under elbow when supine for 6-8 weeks to avoid shoulder hyperextension/anterior capsule stretch/subscapularis stretch o Avoid active shoulder IR and passive ER beyond 400 for 6 weeks to protect repair of subscapularis o Avoid active/active-assisted/passive forward elevation beyond 140o for 2 weeks . Initiate Pendulum exercises o Every 2-3 hours for five minute sessions, 25x/each direction . Initiate elbow/forearm AROM and hand squeezing exercises o Hourly, 25 repetitions each . Initiate scapular AROM exercises o Elevation, depression, retraction and protraction o Hourly, 25 repetitions each . Initiate Phase I Stretching Exercises, 3x/day, 10 repetitions each o Supine passive forward elevation in POS to 140o, performed by other person o Supine passive ER in POS to 40o, performed by other person o Supine active-assisted forward flexion with opposite hand to 140o o Supine active-assisted forward flexion with cane to 140o o Supine active-assisted ER with cane to 40o . Ice

Revised 01/2010 Department of Rehabilitation Services 2 Total Shoulder Arthroplasty Rehabilitation Guidelines

POSTOPERATIVE DAY 2-5: . Continue with above until patient is independent with HEP and precautions . Light ADL’s o Hand-to-mouth activities o Handwriting

POSTOPERATIVE 10-14 DAYS (following physician follow-up): . Review/continue current HEP o Pendulum exercises o Elbow/forearm AROM and hand squeezing exercises o Scapular AROM exercises o Phase I Stretching Exercises . Continue to limit ER to 40o . Discontinue 140o restriction for forward flexion at 2 weeks post-op . Initiate shoulder AAROM with overhead pulley, 3x/day, five minutes sessions . Ice

Phase II: 3-8 Weeks Post-op

TREATMENT GOALS: 1. Pain control 2. Increase ADL’s 3. Continue stretching until full PROM is achieved 4. Initiate scapular strengthening exercises

TREATMENT GUIDELINES: . Review/continue current HEP o Pendulum exercises o Elbow/forearm AROM and hand squeezing exercises o Scapular AROM exercises o Phase I Stretching Exercises . Continue to limit ER to 40o until 6 weeks post-op . Discontinue immobilizer/sling at 4 weeks post-op . Initiate Phase II Stretching Exercises, 3x/day, 10 repetitions each o Standing active-assisted extension with cane o Standing active-assisted functional IR with cane o Standing active-assisted cross-body adduction with opposite hand . Initiate scapular and bicep/triceps strengthening o Shoulder shrugs, scapular retraction, biceps and triceps with Theraband o 10 repetitions each, 3x/day

Phase III: 6-12 Weeks Post-op

TREATMENT GOALS: 1. Full, pain-free AROM 2. Increase functional activities 3. Increase strength of scapular stabilizers 4. Initiate shoulder strengthening exercises

TREATMENT GUIDELINES: . Continue Phase I and Phase II Stretching Exercises o Discontinue 40o restriction for ER at 6 weeks post-op o Progress to sustained stretch (10 second hold), 10x/each direction, 3x/day . Initiate UE PNF diagonals . Continue/progress scapular and bicep/triceps strengthening . Initiate isometric strengthening exercises at 6 weeks post-op, EOD, 1-3x10 repetitions o Flexion, extension, IR, ER against wall . Initiate Phase I Strengthening Exercises at 8 weeks post-op, EOD, 1-3x10 repetitions o ER, IR , extension with Theraband . Initiate Phase II Strengthening Exercises at 10 weeks post-op, EOD, 1-3x10 repetitions o Abduction and forward elevation with Theraband

Phase IV: 12-16 Weeks Post-op

TREATMENT GOALS: 1. Full functional activities 2. Return to work or sport

TREATMENT GUIDELINES: . Continue/progress Phase I & II Strengthening Exercises . Work- or sport-specific training . Modification suggestions for work, sport, or functional activities

References

Budoff, J.E., Cornwall, R., & Trumble, T.E. (Eds.). (2006). Hand, elbow & shoulder: core knowledge in orthopaedics. Philadelphia: Mosby Elsevier.

Callahan, A.D., Mackin, E.J., Osterman, A.L., Schneider, L.H., & Skirven, T.M. (Eds.). (2002). Rehabilitation of the hand and upper extremity. St. Louis, MO: Mosby, Inc.

Hand Rehabilitation Center of Indiana. (2001). Diagnosis and treatment manual for physicians and therapists (3rd ed.). Indianapolis, IN: Hand Rehabilitation Center of Indiana.

Revised 01/2010