Anatomic Total Shoulder Replacement
Download this rehabilitation protocol (PDF)
For patients and physiotherapists.
Week 0-2
Aims:
- Pain control
- Protect the replacement
- Allow wounds to heal
- Maintain overall mobility
- Axilla/armpit hygiene
Suggested treatment:
- Ice
- Regular pain relief
- Elbow/wrist/hand and neck ROM exercises
- Sling most of the time; off for hygiene
Week 2-6
Aims:
- Wean out of sling
- Maintain wrist/elbow/hand/neck ROM
- Start active assisted ROM
- Protect subscap repair/limit ER
- Protect from dislocation/limit extension
Suggested treatment:
- Passive ROM with ER and extension limits (to neutral only)
- Active assisted flexion and abduction
- Active assisted ER to neutral
- Peri-scapular strengthening
- No heavy lifting including no supporting body weight with operated arm
Weeks 6-12
Aims:
- Aim for no sling
- Improve on functional ROM/ADLs
Suggested treatment:
- Progress to full passive ROM including no ER restriction and extension
- Strengthening – periscapular, rotator cuff and deltoid
- Commence functional extension behind the back
- No heavy lifting including no supporting body weight with operated arm
Beyond 12 weeks
Aims:
- Functional shoulder range and strength
- Gradual return to hobbies and sport
Suggested treatment:
- No restrictions
- Gradually increasing weight bearing and lifting as tolerated
Some General Questions
What to expect after surgery:
- Most patients will stay 1-2 nights post operatively
- After you wake up, you may notice your whole arm feels numb from the local anaesthetic applied to the nerves of your arm – this should wear off approximately 12 hours after surgery
- You will be seen by the physiotherapists prior to your discharge
- You will be sent home with medications or a script to help with pain relief
Time in Sling:
- Generally your sling should be on at all times (except for hygiene) in the first 2 weeks
- From 2-6 weeks, you can wean out of the sling gradually using it less and less each day. You do not need to use your sling at night/sleeping
- From 6 weeks, you should not need to use your sling at all
Return to Activity
- Driving: when adequate range of motion and pain to allow safe control of the car and to react appropriately in an emergency. Both arms must be fully functional and on the wheel for this to occur. Usually dependent on time in sling.
Return to driving from 4 to 6 weeks post op for automatic cars; 8-10 if manual - Work: desk based roles should be able to return once pain has settled – usually approximately 2 weeks after surgery. Those with more manual occupations may need specific recommendations and light duties are usually recommended
- Swimming: water based exercise is very helpful after surgery. No swimming until the wounds have healed – usually 2 weeks post operatively. Breaststroke by 12 weeks and freestyle by 4-6 months.
- Golf, Tennis: usually requires significant rehab and time before adequate protection of the rotator cuff repair has occurred. Usually 3 to 6 months post op
Concerns or questions?
If you have any concerns post operatively, or you would like further information, please contact Mr Lau through the VBJS on 03 5752 5020 or via email at admin@vbjs.com.au
If you need urgent medical help, call 000 or go to your nearest emergency department.
Patient information
These notes have been prepared by Mr Simon Lau. They are general overviews and information aimed for use by his patients. They reflect Mr Lau’s views, opinions and recommendations. They do not constitute medical advice. The contents are provided for information and education purposes only. Please seek Mr Lau’s specific advice with any questions regarding medical conditions and treatment.