Total Shoulder Arthroplasty/Hemiarthroplasty Protocol

Phase II – AROM (6-10 weeks):Goals:Restore full passive ROMGradually restore active motionDo not overstress healing tissueRe-establish dynamic shoulder stabilityPrecautions:Sling used only for sleeping, discontinued by week 8. Place pillowbehind elbow so patient can see elbow at all timesNo lifting, pushing, pulling (empty tea cup is maximal weight)No supporting of body weight by hand on involved sideEarly Phase II:Focus on PROM and AROM in scapular plane continue with PROM,active assisted range of motion (AAROM)Scapular strengthening exercises as appropriateBegin assisted horizontal adductionProgress distal extremity exercises with light resistance asappropriateGentle glenohumeral and scapulothoracic joint mobilizations asindicatedInitiate glenohumeral and scapulothoracic rhythmic stabilizationContinue use of cryotherapy for pain and inflammation.Late Phase II:Progress scapular strengthening exercisesPatient may progress to next phase: Minimal pain

Has achieved at least 140° PROM forward flexion and elevationin the scapular plane. Has achieved at least 60+° PROM ER in plane of scapula, 70degrees IR in 30 degrees of abduction Able to actively elevate shoulder against gravity with goodmechanics to 100°.Phase III – Early Strengthening (10-14 weeks):Goals:Gradual restoration of shoulder strength, power, and enduranceOptimize neuromuscular controlGradual return to functional activities with involved upperextremityPrecautions: No heavy lifting of object greater than 5 lbs. No sudden lifting or pushing activitiesEarly Phase III:Continue motion exercises, may start to improve IRResisted shoulder IR, ER in scapular planeBegin progressive supine active elevation strengthening (anteriordeltoid) with light weights (1-2 lbs) at variable degrees ofelevationLate Phase III:Resisted flexion, elevation in the plane of the scapula, extension(therabands / sport cords)Continue progressing IR, ER strengtheningProgress IR stretch behind back from AAROM to AROM as ROM allows(Pay particular attention as to avoid stress on the anterior capsule)

Phase IV – Advanced strengthening (>14 weeks):Goals:• Maintain non-painful AROM• Enhance functional use of upper extremity• Improve muscular strength, power and endurance• Gradual return to more advanced functional activitiesPlease note patients with rheumatoid arthritis, fractures and otherpathology will have different criteria for progression to the next phase.Their disease processes may limit gains when compared to otherpatients.