1675 E. Melrose St.
Gilbert, AZ 85297

480.964.2908

Hospital for Special Surgery

University of Utah

Kerlan-Jobe Orthopaedic Clinic

Arizona Spine & Joint Hospital
Banner Baywood Medical Center
Banner Ironwood Medical Center
Banner Gateway Medical Center
Gateway Surgery Center
Mercy Gilbert Medical Center
Phoenix Children’s Hospital
Arizona General Hospital–Mesa

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THERAPY PROTOCOL FOR TOTAL SHOULDER ARTHROPLASTY

Note: While this is intended to be a guide, please tailor progression to the patient’s surgical procedure and response to treatment. The diagnosis, the surgery performed, and the patient’s pre-operative level all play important roles in the post-operative period. This protocol is a general timeline, and can be accelerated or decelerated according to each individual situation. The protocol is NOT intended to be a comprehensive outline of all activities and restrictions.

This therapy protocol is intended for current patients of Dr. Hansen who are actively under his care.  Dr. Hansen reserves the right to change all or part of this protocol based on individual patient progress. Please contact our office if you have questions or concerns.

Thank you for your care of our shared patient!

Frequency: 2-3 times per week for 12 weeks

General Information:

• Surgery may also include one or more of the following:
  • Subscapularis repair
  • Biceps tenodesis
• Emphasis on early ROM to prevent contracture

1)      Phase 1: Weeks 0-4

Goals: Decrease soreness and swelling, gently increase passive range of motion to tolerance, inhibit further muscle atrophy

1. Precautions
   1. Use sling night and day for 6 weeks WITH ABDUCTION PILLOW
   2. No lifting, pushing, pulling or carrying surgical arm

• No AROM biceps to protect biceps tendon repair

1. NOTE: Surgery includes subscapularis repair, may include biceps tenodesis
2. Day of surgery:
   1. Pendulums
   2. PROM elbow

• AROM wrist/hand

1. Cold therapy

1. Weeks 0-3
   1. PROM only as tolerated
      • IR to 30 degrees
      • ER to 15 degrees
      • Flexion to 120 degrees
   2. Deltoid isometrics

2)         Phase 2: Weeks 4-6

Goal: Advance PROM

1. Precautions
   1. Use sling night and day for 6 weeks WITH ABDUCTION PILLOW
   2. No lifting, pushing, pulling or carrying surgical arm
2. Weeks 4-6
   1. Advance PROM as tolerated
      • IR to 45 degrees
      • ER to 45 degrees
      • Full flexion

3)         Phase 3: Weeks 7-8

Goal: Advance AROM

1. Precautions
   1. Discontinue sling at 6 weeks
   2. No lifting, pushing, pulling or carrying surgical arm
2. Weeks 7-8
   1. Advance AAROM and AROM as tolerated

4)      Phase 4: Weeks 9-12

Goals: Full AROM, initiate strengthening

1. Precautions
   1. No lifting >5 lbs
2. Weeks 9-11:
   1. Full AROM as tolerated
3. Week 10-12:
4. Gradual advancement of strengthening if full AROM achieved

5)      Phase 5: Weeks 12+

Most patients will complete therapy between weeks 12-16 in favor of a home program

1. Weeks 12-16:
   1. Gradual strengthening & work hardening

Guide to advance activity (as tolerated and pending surgeon approval):

• 3 weeks: sedentary work
• 6-8 weeks: driving if small tear
• 10-12 weeks: driving if large tear
• 3-4 months: manual job, advance sport specific activities
• 4+ months: advance activity as tolerated, initiate golf advancement