Total Shoulder Replacement

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Severe osteo or rheumatoid arthritis where the predominant feature is pain


   In Patient
Day 0
Day 1
  • Body belt removed
  • Axillary hygiene taught
  • Pendular exercises
  • Scapular setting
  • Passive flexion in the scapula plane as comfortable 
  • External rotation to neutral
   Out Patient
Day 5-3 weeks
  • No resisted internal rotation or forced passive external rotation (reattached subscapularis muscle is vulnerable)
  • Begin passive abduction (maintain shoulder in IR)
  • Passive external rotation to neutralonly 
  • Active assisted flexion in supine and progress to sitting position as soon as the patient is able.
  • Progress to active when possible
  • Begin isometric strengthening of all muscle groups (except IR)
  • Remove sling as able
  • Functional reaching activities below 90 degrees
3 weeks +
Level 2 exercises
  • Encourage active movement into all ranges with some gentle self-stretching at the end of range.
  • Add isometric IR
  • Progress functional activities
6 Weeks +
  • Progress strengthening through range 
  • Regularly stretch the joint to the end of its available range
  • Soft tissue manipulation if required
Week 3 50% of pre-op active ROM
Week 6 Passive ROM to at least pre-op level
Week 12 Active ROM to at least pre-op level

Improvement continues for 18 months to 2 years and the patients should continue exercising until their maximum potential has been reached

Return to functional activities

Driving After 4 weeks
Golf 3 Months
Lifting Light lifting can begin at 3 weeks.
Avoid lifting heavy items for 6 months.
Return to work Sedentary job: 6 weeks
Manual job: Guided by Surgeon