Shoulder Rehabilitation

Anatomic Shoulder Replacement Rehabilitation

SLING

WHEN DO
I START PHYSIO?

WHEN CAN
I START DRIVING?

4 weeks.

You will begin physiotherapy two weeks after your operation.

In approx 4-6 weeks, when you’re no longer using the sling and havefull control of the vehicle.

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

LIFTING

SWIMMING

GOLF

Light lifting at 8 weeks. Avoid heavy lifting for 6 months.

Breaststroke 8 weeks, freestyle 12 weeks.

3-6 months.

Devinder Garewal
SHOULDER SPECIALIST

Mr. Devinder Garewal

MBBS, BMedSci, FRACS (Orth), FAOrthA

Mr. Devinder Garewal is an orthopaedic shoulder specialist. Devinder completed his medical qualifications from the University of Melbourne and is a Fellow of the Royal Australasian College of Surgeons and the Australian Orthopaedic Association.

Shoulder Bone Icon

Shoulder Joint

Elbow Icon

Elbow Joint

Wrist Icon

Wrist Joint

Hand Icon

Hand Joints

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