Anatomic Shoulder Replacement Rehabilitation

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