TOTAL SHOULDER ARTHROPLASTY PROTOCOL

Days O - 7 

• Patient to do Home Exercises given post-op (pendulums; ROM elbow, wrist, hand, grip strengthening)
• Patient to remain in sling for 6 weeks AT ALL TIMES (except for personal grooming)

Weeks 1 - 6

• True PROM only! The rotator cuff tendon (subscapularis) is healing back to the bone
• ROM goals: Max 90° FF/ 0 ° ER at side; Abd max 60° without rotation
• Grip strengthening
• Table slides
• Heat before PT/ Ice after PT
• No resisted motions of the shoulder until 12 weeks post-op!
• No canes/ pulleys until 6 weeks post-op, because these are active assist exercises

Weeks 6-12

• Begin AAROM
• Advance to AROM as tolerated
• ROM Goals: Same as above, but can increase as tolerated
• Light passive stretching at end ranges
• Begin scapular exercises, passive resistance exercise for large muscle groups (pees, lats, etc)
• Isometrics with arm at side beginning at 8 weeks

Months 3-12

• Advance to full ROM as tolerated with passive stretching at end ranges
• Advance strengthening as tolerated: isometrics -> bands -> light weights (1-5 pounds) with 8 -12 reps / 2 - 3 sets for rotator cuff, deltoid, and scapular stabilizers)
• Only do strengthening 3x/week to avoid rotator cuff tendonitis
• Begin eccentrically resisted motions, plyometrics (ex. weighted ball toss), proprioception (ex. Body blade) 
• Begin sports related rehab at 4 ½ months, including advancing conditioning
• Return to throwing at 6 months
• Throw from pitchers mound at 9 months
• Collision sports at 9 months
• MMI usually at 9 - 12 months post-op