Department of Rehabilitation Services 1
Total Shoulder Arthroplasty Rehabilitation Guidelines
Department of Rehabilitation Services
Total Shoulder Arthroplasty Rehabilitation Guidelines
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
Revised 01/2010
Department of Rehabilitation Services 3
Total Shoulder Arthroplasty Rehabilitation Guidelines
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