Overview
In order to perform a total shoulder replacement, the subscapularis (one of the rotator cuff muscles) must be cut and then repaired back in place.
It is critically important that the subscapularis heals properly.
The primary goal of rehabilitation after total shoulder arthroplasty is to maintain range of motion (ROM) while protecting the subscapularis repair.
Work and Activity Restrictions
• 0–2 weeks: No work, no use of operative hand.
• 2–6 weeks: Discontinue sling and begin formal physical therapy.
– May use hand for activities of daily living (ADLs) only.
– Nothing in the operative hand heavier than a fork, knife, or toothbrush.
• 6 weeks–3 months: Less than 5 lb weight bearing in operative hand.
– Cleared to return to work for opposite-hand-only duties.
• 3 months+: No restrictions; resume normal activity as tolerated.
Rehabilitation Phases
0–2 Weeks: Wound Rest
• Sling at all times except when performing elbow, wrist, and hand exercises.
• Elbow, wrist, and hand exercises 3–5 times per day:
– Flexion and extension of the elbow, wrist, and hand.
2–6 Weeks: Protect Repair / Maintain Motion
• Discontinue sling during the day; continue to wear it at night.
• Begin physical therapy with JPL Exercises Phase I and gentle pendulum exercises.
– Perform 3–5 sets of JPL exercises per day, 5 repetitions per set.
• Avoid external rotation past 20 degrees.
• Continue elbow, wrist, and hand exercises 3–5 times daily.
6 Weeks–3 Months: Regain ROM
• Continue formal physical therapy.
• Transition to Phase II of JPL Exercises when comfortable with Phase I.
• Transition to Phase III of JPL Exercises when comfortable with Phase II.
• If a warm pool is available, begin pool exercises.
• Begin active and passive ROM exercises.
– Remove external rotation restrictions.
• Begin rope and pulley exercises and table slides for terminal passive elevation.
• Begin gentle strengthening with theraband: external rotation, low row, anterior deltoid.
• Maintain a 5 lb weight limit on the operative side.
• Perform stretching routine 3–5 times per day.
3 Months+: Strengthening
• Weight bearing as tolerated.
• No ROM restrictions.
• Continue progressive strengthening and functional activities as tolerated.
