Recovering from total shoulder replacement surgery requires proactive work from the patient to ensure success. In this article, we are going to walk through some of the goals and guidelines for recovering from total shoulder replacement surgery.
Goals & Guidelines:
After total shoulder replacement surgery, the first phase of therapy is 6 weeks and is focused on active assisted range of motion exercises only. During this time the patient may work on scapular protraction and retraction for strengthening but no strengthening exercises for deltoid or rotator cuff (RC).
The patient is allowed to use the operative arm for waist level and midline activities such as personal hygiene care but is to do no lifting, pushing or pulling with the arm. The shoulder immobilizer only needs to be worn when outside the home for the first six weeks. If the patient feels more comfortable with the sling, then he/she may wear it at home as well but it is not necessary. For the first couple weeks, most patients are more comfortable sleeping in their sling and a recliner but they may move to a bed when comfortable. While sleeping in bed the patient is to place a pillow or a stack of blankets under the elbow and arm of the operative extremity in order to have the arm/shoulder in the plane of the body (extension of the shoulder is both painful and stresses the repair). Therapists should teach the patient how to perform proper axillary hygiene by bending over at the waist (like doing pendulum exercises).
The second phase of therapy is about 2 months and focuses on continued stretching (which can be more aggressive) and strengthening. The strengthening starts slowly and progresses to functional exercises. Whether using bands or weights, the strengthening should not be painful and focus on a resistance with which the patient can perform 10-15 reps comfortably. Most patients are able to play a round of golf at 4 months postop and are released to more aggressive activities at that point but improvements in strength and function continue for up to 2 years.
