Total Shoulder Replacement Rehab Protocol

Keys to a Successful Outcome

Early protection of the subscapularis is essential to its integrity. This is the main reason 4–6 weeks of bracing is required and AROM and strength exercises are delayed until 6 weeks from surgery.
Never over-stress the anterior shoulder/capsule.
While lying supine for the first 6 weeks, a small pillow or towel roll should be placed behind the elbow to avoid shoulder hyperextension / anterior capsule stretch / subscapularis stretch.
Forceful stretching and mobilization/manipulation is NEVER indicated at any phase of therapy.

Phase	Brace	ROM	WB	Exercises
In Hospital	Worn at all times*	PROM only	NWB	Passive FF while supine; gentle ER in scapular plane (documented in Op Note), passive IR to chest, pendulum okay if comfortable
Weeks 0-6	Worn at all times*	PROM only	NWB	Elbow/wrist AROM, grip strength, scapular isometrics, no resistance exercises, PROM goals; FF 90°, ER 45°, IR 90°(measured at 30° abduction)
Weeks 6-12	Used for sleeping**	Begin AAROM -> AROM as tolerated	1lb	Begin AROM in scapular plane; AAROM pulleys, pain-free isometrics in neutral, scapular strengthening, assisted horizontal add; PROM goals: FF 140, ER 60, IR 70; active FF to 100
Weeks 12-16	None	Progress AROM/PROM as appropiate	5lb	Assisted IR behind back stretch, resisted IR/ER in scapular plane, begin active elevation strengthening (i.e. Therabands); AROM goals: FF 140 (scapular plane supine), ER 60/IR 70
Months 4-6	None	FAROM	10lb	Gradually progress strengthening, return to light recreational hobbies (gardening, light sport activities)
Months 6-12	None	FAROM	15lb	Avoid exercise and functional activities that put stress on the anterior capsule (i.e. combined ER and ABD)

*Worn day and night; off for therapy/hygiene

**Used for sleeping only from weeks 6-8 and removed gradually during the day