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Total Shoulder Replacement Rehabilitation Guidelines
The following is a detailed outline of the rehabilitation regime for patients who have had a
Total Shoulder Replacement by Dr. Macgroarty.
Each case can be very different depending on the goals of the patient, the age of the
patient, the size of the repair, type off repair, etc. We follow these basic guidelines. Any
physician indicated precautions override these guidelines
You will have a sling which should be worn day and night for 6 weeks post operatively. The
aim of the sling is to take some of the pressure of the surgical site. You can remove the sling
for the recommended exercises and when sitting quietly - but keep the arm rested on pillows
or arm rest.
12-16 hours post op
If local anaesthetic block used
The block affecting your arm will begin to wear off, so it is advisable to begin taking
the pain killers prescribed for you (eg. Panadeine osteo).
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Day 1 to week 6 (stage 1)
What to expect
The pain is often worse at night, especially the first few nights.
Don’t forget to use ice and your pain medication.
Some patients find it more comfortable to sleep a little more vertical, for instance a
recliner.
An increase in body temperature is common following an operation.
Don’t forget to wear the sling when you are up and about, and to rest your arm on a
pillow or arm rest when you are sitting quietly.
Your wound is cover by a waterproof dressing, you can shower normally.
Your first post-operative appointment should be on week 2. We will remove the
dressing and review the operation with you.
You will not be able to drive until the sling is off and you can lift your arm
comfortably shoulder height (8 weeks).
No lifting or overhead work
Start the following exercises
Some gentle exercises are outlined below. During these exercises, there is to be NO
ACTIVE MOVEMENT of the operated arm. You are to use your opposite arm to assist with
movements, or allow gravity to move your body into position for exercises such as the
pendulum.
Do each exercise the number of times recommended.
All exercises should be done 3 to 5 times a day as your pain allows.
Absolutely NO lifting.
Avoid too much early active use.
1. Bend and straighten elbow
Use your opposite arm to assist with the
movement of the affected arm initially.
REPEAT 10 times
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2. Passive Shoulder Flexion
Place hands on top of a bench or chair at
waist height.
Step backwards, keeping the arms straight.
Bend from the hips and lower your trunk
between your arms.
You should feel a stretch in your shoulder.
Hold gently for 10-15 seconds.
REPEAT 5 times
3. Hand Squeeze
The hand squeeze exercise will improve
your hand strength.
Squeeze the fingers of your hand in
towards your palm.
Hold for 5-10 seconds, then release.
You can use a squeeze ball if you have one
available, but it is not necessary.
REPEAT 10 times
4. Neck Stretch
Gently stretch your neck from side to side.
REPEAT as required
5. Passive Pendulum
Gently let the affected arm fall away from
your body as you slowly bend forward
from the hips.
Aim for a 90 degree angle between your
body and your arm.
Hold this position for 10 seconds.
REPEAT 5 times
Total Shoulder Replacement 3
6. Passive External Rotation
Stand with your affected arm up against a door
jamb.
Assist your elbow to bend to 90 degrees and
keep your arm resting across the front of your
waist (just as if it was in the sling).
Using a stick or your other hand, push your
affected arm away from your body until you
get a stretch.
Hold gently at this point for 5-10 seconds.
REPEAT 5 times
7. Posture
When you no longer need to wear your
sling, it is important to stretch your back
and shoulders to regain your pre surgery
posture.
Posture is important especially for a good
functioning shoulder.
Gently roll your shoulders a few times and
squeeze your shoulder blades together.
Gently hold this position for 10 seconds.
REPEAT 5 times
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Week 6 – 12
What to expect
You can stop wearing the sling.
You can book your first physiotherapist appointment.
Your second post-operative appointment will be around week 8-10
No overhead activities
You can lift up to 1kg to your waist.
You can drive when you are able to lift your arm shoulder high (around week 8)
Start the following exercises, after your
second post-op appointment
All exercises should be done 3 times a day
1. Flexion stretch
Slide both arms up a wall with palm facing
towards you. Move closer to the wall as
the arms slide upwards.
5 Repetitions
2. Active supported external rotation
Sit at a table with the elbows bent at 90º,
by your side and sup- ported on top of the
table.
Keeping your shoulder blades still, slide
the operated side fore- arm so that it
swings outwards, away from your body.
10 Repetitions
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Place operated arm behind back and use
the unaffected arm to pull up the one that
has had surgery. 10 Repetitions
3. External-internal rotation
Lay down on your back.Hold stick with
good handin under grip andoperated hand
in a top grip, elbows bent at 90º.
Usingyourgoodhandgentlypushthesticktow
ards the operated side ofyour body, making
sureyou keep the elbow ofyour bad arm by
your side.
10 Repetitions
4. Shoulder flexion
Lie down on your back.
Take hold of a stick with both hands
placed wider thanshoulder width apart.
Lift your arms above your head until you
feel a stretch, use your good armto
movethe operatedarm.
Gently hold at this point for 10 seconds.
10 Repetitions
5. Shoulder extension
Hold the stick using an underhand grip
behind your back.
Push the stick backwards away from your
back. 10 Repetitions
6. Back towel stretch
Grasp towel in both hands.
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Week 6 – 3 months phase 2- Isometric strengthening exercises
All pushes should be gentle. Don’t push through pain. Follow your physiotherapist
recommendations.
10 repetitions of each, 3 times a day
1. Isometric flexion
3. Isometric adduction
With your forearm in front of you, pull the
operated hand towards your head against Squeeze a pillow into your body with the
the good hand which is kept still, elbow and arm. Keep the neck relax and
providing resistance. the shoulder blades pinched together.
2. Isometric Extension
4. Isometric External Rotation
Push your elbow and arm back into the
wall. Keeping your elbow by your side, press
your forearm so that it swings outwards in
the direction of the wall.
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3 months – 6 months (stage 3)
What to expect
You can commence light lifting gradually up to 5-10kg.
You can start occasional overhead work of less than 15 minutes duration.
You can commence Stage 3 exercises.
Theraband exercises
Perform theraband exercises in series of ten 3 times (30times), twice a day.
1. Theraband rowing 2. Theraband resistance adduction
Hold each end of the theraband. Pull both Pull the theraband down towards your
arms back in a rowing motion. Keep your body.
elbows bent; pinch shoulder blades
together as you pull back- wards.
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Repeat, but pull the theraband away
from your body.
3. Theraband resistance internal and
external rotation
With elbow at your side, Pull the
theraband inwards towards the front
of your body.
4. Straight arm lifts
Lift your operated arm forward up towards
the ceiling. Keep your elbow straight and
thumb facing up. When you are able to do
this, you can add weights.
Milestones
Return to full duties work
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