Shoulder and Elbow

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Shoulder Replacement Postoperative Protocol

Phase 1 (0-6 Weeks) Joint protection

  • Sling for 6 weeks. May come out for showers and exercise
  • Prevent the shoulder falling into extension by placing a folded towel/pillow behind the elbow when lying
  • Actively move hand, wrist and elbow. Create awareness of good static scapula position
  • Passive ROM exercises
  • Circular pendulum / Forward flexion 90-120 degrees / External rotation 20 degrees
  • No resisted internal rotation e.g. pulling bed sheets up, hand behind back activities
  • No weight bearing e.g. pushing up out of chair, propping up in bed

Phase II (6-12 weeks) Passive ROM

  • May wean from sling
  • May use shoulder for self care and light activities of daily living eg wiping bench, light kitchen tasks
  • Progress passive range of motion exercises to a functional range (flexion 140-150, external rotation 45 – further range maybe possible on guidance from the surgeon). Commence assistive active and active range of motion exercises into flexion, abduction, external rotation e.g. pulley, stick flexion supine, walk up wall, ‘polishing’, gentle hand on head
  • Soft tissue massage, gentle manual passive stretches and scapula awareness
  • Late phase II (week 9) can start active horizontal flexion, gentle extension and hand behind back range of motion
  • Driving – start at 6 weeks if capable
  • Once active range = passive range = 90% goal range may start light resisted strengthening

Phase III (12+ weeks) Strength and Function

  • Start initially on rotator cuff strength and endurance e.g. small weight ER/IR, therabands. Progressively work on deltoid, biceps, triceps and pecs as able. Keep weighted exercises in keeping with patient’s functional expectations.
  • Return to recreational activities (e.g. golf, bowls, gardening) over 6 week period.