PHYSICAL THERAPY PROTOCOL
Total Shoulder Replacement
Physical Therapy Protocol
Rehabilitation following anatomic total shoulder replacement is designed to restore comfortable motion, protect the soft tissue repair, and progressively return patients to normal daily activities while preserving the longevity of the shoulder replacement.
Protect Repair
Restore Motion
Strengthening
Comfortable Function
Important Note
This protocol serves as a general guideline. Individual patients may require modifications based on bone quality, subscapularis repair, associated procedures, revision surgery, or surgeon preference. The surgeon's postoperative instructions always take precedence.
Rehabilitation Philosophy
Unlike reverse shoulder replacement, anatomic shoulder replacement relies on a functioning rotator cuff and healing of the subscapularis repair. Early rehabilitation emphasizes protecting the soft tissues while gradually restoring motion. Strengthening progresses only after adequate healing has occurred.
Phase I: Protection Phase
Timeframe: 0–6 Weeks
Goals
- Protect the subscapularis repair
- Control pain and swelling
- Restore gentle passive motion
- Maintain elbow, wrist, and hand motion
- Prevent stiffness
Sling
- Sling for comfort and protection
- Remove for hygiene and exercises
- Sleep in sling if instructed
- No lifting with the operative arm
- No active internal rotation
Exercises
- Pendulum exercises
- Passive forward elevation
- Gentle passive external rotation within prescribed limits
- Elbow, wrist, and hand motion
- Grip strengthening
- Scapular retraction exercises
Avoid
- Active internal rotation
- Resisted internal rotation
- Pushing up from a chair
- Heavy lifting
- Sudden shoulder movements
Phase II: Motion Phase
Timeframe: 6–12 Weeks
Goals
- Restore passive motion
- Progress active-assisted motion
- Begin active motion
- Normalize scapular mechanics
- Gradually discontinue sling
Exercises
- Cane-assisted exercises
- Table slides
- Pulleys
- Wall walks
- Scapular stabilization
- Gentle stretching
Phase III: Strengthening
Timeframe: 12–18 Weeks
Goals
- Restore strength
- Improve endurance
- Normalize shoulder mechanics
- Improve function
Exercises
- Theraband strengthening
- Light dumbbell strengthening
- Rotator cuff strengthening
- Deltoid strengthening
- Scapular strengthening
- Functional strengthening
Phase IV: Advanced Function
Timeframe: 18+ Weeks
Strength
Progress resistance as tolerated while maintaining excellent mechanics.
Function
Advance work, recreational, and sport-specific activities.
Endurance
Build tolerance for repetitive shoulder use.
Return To Activity Guidelines
Desk Work
Usually 1–2 weeks depending on comfort.
Driving
When off narcotic pain medication and safely controlling the vehicle.
Daily Activities
Gradual progression after sling discontinuation.
Golf
Putting approximately 6 weeks, chipping 8–10 weeks, full swing typically 4–5 months.
Fitness
Progressive strengthening after 12 weeks.
Heavy Lifting
Gradually resume only after adequate healing and surgeon clearance.
Therapist Notes
- Protect the subscapularis repair during early rehabilitation.
- Avoid aggressive external rotation early.
- Prioritize quality of motion over speed of progression.
- Restore normal scapular mechanics.
- Delay strengthening until appropriate soft tissue healing.
- Contact the office if recovery deviates significantly from expectations.
Red Flags
Contact The Office For
- Increasing pain
- Drainage
- Increasing redness
- Loss of motion
- Loss of shoulder function
Seek Urgent Care For
- Chest pain
- Shortness of breath
- Calf pain or swelling
- Severe uncontrolled pain
Related Resources
Questions About Total Shoulder Replacement Rehabilitation?
Successful rehabilitation balances protection of the soft tissue repair with gradual restoration of motion and strength, allowing patients to return to comfortable daily activities while maximizing the longevity of their shoulder replacement.
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