Shoulder Arthroplasty Protocol

16-03-16_Physical-Therapy-Rehabilitation

Shoulder Arthroplasty Protocol

This rehabilitation protocol has been developed for the patient following a shoulder arthroplasty (replacement) procedure. This protocol will vary in length and aggressiveness depending on factors such as:

  • Presence of a functional rotator cuff (intact or repaired)
  • Type of shoulder replacement (anatomic or reverse)
  • Presence of a glenoid resurfacing component
  • Arthroplasty performed for arthritis versus fracture
  • Strength/pain/swelling/range of motion status
  • Rehabilitation goals and expectations

Early passive range of motion is highly beneficial to prevent stiffness, but must be performed within the limits defined during surgery to allow healing. The protocol is divided into phases. Each phase is adaptable based on the individual and special circumstances. The overall goals of the surgical procedure and rehabilitation are to:

  • Relieve pain associated with arthritis
  • Regain or improve upon pre-operative shoulder range of motion
  • Regain upper extremity strength and endurance
  • Achieve a level of function based on the pre-operative goals

Important post-op signs to monitor:

Physical therapy may be initiated the day after surgery in the hospital. After discharge, a supervised rehabilitation program may be prescribed, and is to be supplemented by a home fitness program where the patient performs the given exercises at home or at a gym facility. Important post-op signs to monitor:

  • Swelling of the shoulder and surrounding soft tissue
  • Abnormal pain response, hypersensitive-an increase in night pain
  • Severe range of motion limitations
  • Weakness in the upper extremity musculature
  • Persistent drainage from the incision

Rehabilitation requires both time and clinical evaluation. To optimize function post-operatively, the patient requires adequate strength, flexibility, and endurance. Symptoms such as pain, swelling, or instability should be closely monitored by the patient.

Download PDF

Rehabilitation Protocols

Phase 1: Week 1-6 Shoulder Arthroplasty

1ROM

  • NO active shoulder motion for the first 3 weeks
  • Begin active flexion, extension, abduction and external rotation week 3-4
  • Pendulum exercises
  • Elbow, wrist and hand range of motion
  • Gentle posterior capsular stretching (Anatomic only)
  • Passive ROM and AAROM
    • If rotator cuff intact or repaired:
      • Forward flexion 0-120° week 1, 0-140° week 2
      • External rotation at side 0-20° week 1, 0-40° week 2
      • Abduction at 0° rotation 0-75° weeks 1-2
    • If rotator cuff deficient:
      • Forward flexion 0-90° week 4
      • External rotation at 30° abduction 0-20° week 4
      • Internal rotation at 30° abduction 0-30° week 4
    • For Reverse arthroplasty:
      • Forward Flexion >120° week 4, >140° week 6
      • External rotation at side >30° week 4, Full week 6
      • NO internal rotation until 4 weeks, then gentle increase

2STRENGTH

  • Grip strengthening with putty or ball

3BRACE

  • Shoulder brace for 7-10 days or as instructed
  • Brace removed to perform exercises above

4MODALITIES

  • E-stim and ultrasound as needed
  • Moist heat before, ice after for 15-20 minutes

GOALS OF PHASE:

  • Promote healing of subscapularis +/- rotator cuff if repaired
  • Control pain and inflammation
  • Restore nearly full ROM
  • Delay muscle atrophy

Phase 2: Week 6-12 Shoulder Arthroplasty

1ROM

  • Increase active ROM in all planes
  • Grade I-II joint mobilizations
  • Pendulum exercises
  • Elbow, wrist and hand range of motion
  • Rope/Pulley (flex/abd/scaption)
  • Posterior capsular stretching
  • Initiate gentle ER stretching
  • Anatomic arthroplasty:
    • Forward flexion 0-160°
    • External rotation at side 0-60°
    • Abduction in 40° ER and IR 0-90°
  • Reverse arthroplasty:
    • Forward flexion 0-140°
    • External rotation at side 0-45°
    • Avoid active internal rotation

2STRENGTH

  • Limit cuff strengthening to 3x/week
  • Continue grip strengthening as needed
  • Initiate submaximal isometrics in external rotation and abduction at week 6
  • Initiate supine AROM exercises without resistance
  • Theraband strengthening
    • External rotation and abduction only
    • Done with elbow at side and flexed to 90°
    • Performed through arc of 45°
    • Start with minimum resistance, advance to higher resistance bands, then light dumbbells
  • Initiate scapular stabilizer strengthening
    • Shrugs and scapular depression
    • Scapular protraction and retraction

3MODALITIES

  • E-stim and ultrasound as needed
  • Moist heat before, ice after for 15-20 minutes

GOALS OF PHASE:

  • Reach goal ROM without pain
  • Initiate strengthening of rotator cuff while allowing healing
  • Initiate scapular stabilization

Phase 3: Week 12-24 Shoulder Arthroplasty

1ROM

  • Continue all ROM from previous phases
  • Posterior capsule stretching
  • Initiate Grade II-IV joint mobs as needed

2STRENGTH

  • Limit to 3x/week
  • Continue with all strengthening from previous phases increasing resistance and repetition
  • Add internal rotation and extension strengthening
  • Continue scapular stabilizer strengthening
  • Deltoid strengthening
  • Plyometric exercises

3MODALITIES

  • Continue as needed

GOALS OF PHASE:

  • Gradual return to functional activities
  • Reach full ROM
  • Improve upper extremity strength, power and endurance
  • Enhance neuromuscular control and shoulder proprioception
  • Home program with daily ROM exercises and strengthening 3x/week
  • If rotator cuff is deficient, ROM and strengthening to be done within available limits

Schedule an Appointment

For more information or to schedule an appointment with one of our specialists, contact us today. For your convenience, you may also fill out the form to the right to set up an appointment.