Shoulder Arthroplasty Rehabilitation Guidelines

Shoulder Arthroplasty Rehabilitation Guidelines

(Total, Hemi, and Resurfacing Procedures)

Introduction

Rehabilitation following shoulder arthroplasty aims to restore function while protecting soft tissues, especially the subscapularis, which is divided and reattached during surgery. Recovery protocols must be individualized based on surgical details and patient needs. Emphasis is on scapulohumeral rhythm (SHR), core stability, and progressive loading.

Rehabilitation Phases

Phase 1: 1–28 Days

Goals:

• Protect the prosthesis and soft tissues:
  • Sling worn at all times except for hygiene and exercises.
  • Introduce hygiene techniques and posture.
• Manage pain and inflammation:
  • Use analgesics, NSAIDs, ice, and maintain shoulder alignment.
• Begin PROM:
  • Pendulum and cradled-position exercises with good SHR.
• Maintain mobility:
  • Perform ROM exercises for hand, wrist, elbow, and neck.
• Prevent muscle atrophy:
  • Introduce sub-maximal, pain-free isometrics (except internal rotation) in neutral (<30% MVC).
• Posture while sleeping:
  • Sling in place; use a pillow beneath the elbow in supine position.
• Begin scar massage after suture removal.

Precautions:

• Sling use for 4 weeks.
• Avoid:
  • External rotation >20°, resisted internal rotation, lifting, excessive extension, or sudden movements.
  • Supporting body weight with the affected limb.
• No driving (right: 6 weeks, left: 8 weeks).

Milestones at 4 Weeks:

• Pain and inflammation well-managed.
• Pre-operative sleep patterns restored.
• Good scapular setting.
• PROM: Flexion to 60°, external rotation to neutral.

Phase 2: 5–8 Weeks

Goals:

• Allow soft tissue healing without overloading.
• Progress PROM, AAROM, and AROM as tolerated without pain.
• Re-establish dynamic stability:
  • Gradually progress from PROM to AAROM, then AROM with good SHR.
• Introduce internal rotation isometrics as tolerated.
• Begin light functional activities and lower limb/core strengthening.

Precautions:

• Wean out of sling after 4 weeks (based on surgeon’s instructions).
• Avoid lifting, excessive extension, and weight-bearing on the operated arm.
• No driving.

Milestones at 8 Weeks:

• Pain and inflammation well-managed.
• AAROM: Flexion to 90°, external rotation to 30°.
• Good SHR during PROM.

Phase 3: 9–14 Weeks

Goals:

• Maximize PROM with end-range multi-directional stretching (pain-free).
• Progress from AAROM to AROM with good SHR.
• Begin strengthening:
  • Progress isometrics to isotonic cuff strengthening.
  • Introduce scapular stabilization, proprioceptive exercises, and dynamic stabilization.
• Gradually progress to light functional activities and early sport-specific exercises.

Precautions:

• Avoid heavy lifting or repetitive overhead activities.

Milestones at 14 Weeks:

• Pain and inflammation resolved.
• AROM with good SHR to 100% of pre-operative range.
• Passive external rotation to full pre-operative range.

Phase 4: 3–6 Months

Goals:

• Maintain full PROM with multi-directional end-range stretching.
• Restore full pre-operative AROM with good SHR.
• Progress strengthening:
  • Cuff, scapular stabilization, and proprioceptive exercises.
  • Incorporate dynamic and rhythmic stabilizations.
  • Advance biceps and upper limb strengthening.
• Gradually progress functional and sport-specific activities.

Precautions:

• Avoid:
  • Heavy lifting away from the body.
  • Prolonged or repetitive overhead activities.

Milestones at 6 Months:

• Full, pain-free motion.
• Rotator cuff strength restored.

Phase 5: 6–12 Months

Goals:

• Continue progression from Phase 4.
• Gradual return to strenuous activities, including contact sports if required.

Contact Information

• Consultant Secretary: 07810356433
• Physiotherapy Contacts:
  • Sulis Hospital: 01761 422388
  • Circle Health Group Bath Clinic: 01225 838767
  • St. Joseph Physiotherapy: 01633 820321

Summary of Precautions

• Protect the repair by adhering to restrictions on motion, loading, and specific movements.
• Avoid pain-inducing exercises and prioritize gradual progression.
• Milestones and surgeon instructions guide patient-specific rehabilitation timelines.

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