Shoulder Replacement Rehabilitation

Sling When will I go home? What can I do? What can’t I do?
4 weeks You will be discharged on the day after the operation Range of movement within safe zone* No forced movements or stretching, no lifting

Acute phase (0-4 weeks)

Goals

  • Protect the shoulder replacement
  • Protect the subscapularis repair
  • Allow healing of rotator cuff
  • Regain movement

Rehabilitation

  • *Safe zone: commence passive movement to maximum elevation 90°, external rotation to 30°
  • Progress to active assisted and active supported within this safe zone
  • Elbow, wrist and hand exercises
  • Simple scapular mobilisation exercises
  • Gentle isometric rotator cuff exercises
  • No force or stretch (especially external rotation)
  • No extension/hand behind back
  • No combined external rotation/abduction
  • No internal rotation exercises

Criteria for progression

  • Pain controlled
  • No signs of instability
  • Good isometric contraction of rotator cuff
  • Integrity of subscapularis muscle

Intermediate phase (4-8 weeks)

Goals

  • Control pain
  • Cease sling from 4 weeks
  • Regain functional range of movement
  • Optimise dynamic control through range
  • Avoid over stretching

Rehabilitation

  • Progress range of movement including slowly increasing external rotation without pain
  • Progress active range of movement
  • Continue scapular mobilisation exercises
  • Increase gentle isometric rotator cuff exercises, inclusive of subscapularis from 6 weeks
  • Function extension and hand behind back from 6 weeks
  • Avoid forced movements if pain occurs
  • No resisted internal rotation for first 6 weeks
  • Hydrotherapy permitted

Criteria for progression

  • Painfree well controlled functional range of movement
  • Rotator cuff and scapular control through range
  • Active external rotation control
  • Functioning subscapularis with limb loading

Late phase (>8 weeks)

Goals

  • Rehabilitate subscapularis function
  • Optimise deltoid function
  • Rehabilitate function specific strength and endurance
  • Aid functional independence

Rehabilitation

  • Progress active range of movement with cuff and scapular control through range
  • Introduce rotator cuff resistance exercises including subscapularis from 10 weeks
  • Increase functional use of arm (respecting control/load/fatigue)
  • Functional movement pattern re-education
  • Institute home exercise program (for maximum improvement may take up to 2 years to achieve)

Guidelines for return to functional activities

Driving Lifting Swimming Golf
6 weeks Light lifting 6 weeks, avoid heavy lifting 6 months Breaststroke 8 weeks, freestyle 12 weeks 4 months

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