Anatomic Total Shoulder Arthroplasty

Phase 1 (weeks 0-4):

ROM: 

• Pendulum swings 
• No active ROM of the shoulder  
• No passive ER beyond neutral at weeks 0-2
• No passive ER beyond 30° weeks 2-6 
• Can begin GENTLE passive flexion week 2 
• No internal rotation behind the back

WB: 

• No WB on operative extremity (do not use arm to support body weight)

Sling:  

• Remain in Ultrasling when not doing exercises
• Avoid lifting anything with operative extremity

Therapeutic Exercises:

• pendulum swings, scapula retractions, shoulder shrugs
• AROM exercises elbow, wrist, and hand

Phase 2 (weeks 4-8):

ROM: 

• Weeks 4-6:
  • Continue phase 1 exercises. Begin table slides
• Weeks 6-8:
  • Begin supine active assisted ROM and supine AROM as tolerated 
  • Supine wand exercises: Flexion, abduction, and ER: advance as tolerated  
  • No ER beyond 60 degrees
• Pulleys: flexion, abduction, scaption

WB: 

• No WB on operative extremity (do not use arm to support body weight)
• Avoid lifting anything with operative extremity

Sling:  

• Remain in Ultrasling when not doing exercises until POW 6 then may d/c

Therapeutic Exercises:

• Continue Phase 1 exercises and ROM exercises as above

Phase 3 (weeks 8-12):

ROM: 

• Advance table slides to rail slides and wall slides by week 12  
• Advance supine AROM to seated and standing once adequate scapular control demonstrated  
• Wand exercises: ∙ Flexion, abduction, and ER: advance as tolerated  
• Progress wand exercises from supine to seated to standing once adequate scapula control  
• Pulleys: flexion, abduction, scaption

WB: 

• No WB on operative extremity (do not use arm to support body weight)
• Avoid lifting anything with operative extremity over 2#

Sling:  none

Therapeutic Exercises:

• Shoulder isometrics: all planes  
• Scapular strengthening:  Protraction, retraction exercises, and prone rows  
• Light weight, high rep rotator cuff retraining exercises (may begin at 10wks once adequate scapular control demonstrated)

Phase 4 (weeks 12-16):

ROM: 

• Progress to full ROM without limitations

Therapeutic Exercises:

• Strengthening: 
  • Progress from isometrics to band exercises to light weights for cuff strengthening 
• Scapular stengthening: 
  • Advance resisted rows and scapular stabilization exercises

Gradual return to increased lifting and carrying activities as limited by discomfort

Phase5 (weeks 16+):

Advanced strengthening:

• Continue to advance strengthening exercises for improved dynamic and overhead function of the shoulder  
• No weight bearing limitations