Rehabilitation Protocol

Total & Reverse Shoulder Replacement

Protocol Overview

This protocol provides guidelines for rehabilitation following shoulder replacement surgery. The protocol varies slightly between total shoulder replacement (TSA) and reverse shoulder replacement (RSA). Progress through phases based on tissue healing and functional goals. Always follow specific modifications from Dr. Joshi.

Important: This protocol is provided as a guideline. Always follow the specific recommendations from Dr. Joshi and your physical therapist, as modifications may be necessary based on your individual surgery and healing progress.

Phase 1

Protection & Passive Motion

Weeks 0-6

Goals

Protect the surgical repair and healing tissues
Control pain and swelling
Prevent shoulder stiffness
Maintain elbow, wrist, and hand mobility
Begin passive range of motion

Exercises

Pendulum exercises (Codman's): 2-3 times daily
Passive forward flexion to tolerance (therapist or pulley assisted)
Passive external rotation to 30° (TSA) or 20° (RSA)
Elbow, wrist, and finger range of motion
Scapular squeezes
Grip strengthening with soft ball

Precautions

Sling worn at all times except for exercises and hygiene
No active shoulder motion
No lifting with surgical arm
No pushing or pulling
No reaching behind back (internal rotation)
Sleep in reclined position or with pillows

Criteria for Next Phase

Adequate pain control
Forward flexion 90-120° passive
External rotation 20-30° passive
Minimal swelling

Phase 2

Active-Assisted Motion

Weeks 6-12

Goals

Progress to active-assisted range of motion
Begin to wean from sling
Improve shoulder mobility
Initiate gentle scapular strengthening

Exercises

Active-assisted forward flexion (table slides, wand exercises)
Active-assisted external rotation with wand
Supine active-assisted flexion
Pulley exercises for flexion
Scapular retraction exercises
Isometric deltoid activation (light)
Continue pendulums as warm-up

Precautions

Progress sling weaning as directed
Avoid pain with exercises
No resistive strengthening yet
Avoid combined movements (extension + external rotation)
No heavy lifting

Criteria for Next Phase

Forward flexion 140°+ active-assisted
External rotation 40°+ active-assisted
Good scapular control
Minimal pain with motion

Phase 3

Active Motion & Early Strengthening

Weeks 12-16

Goals

Achieve full active range of motion
Begin gentle rotator cuff and deltoid strengthening
Improve functional use of arm

Exercises

Active range of motion all planes
Isometric strengthening (all directions)
Light resistance band exercises
Wall slides and wall push-ups
Scapular strengthening (rows, Y's, T's)
Light dumbbell exercises (1-2 lbs)
Functional reaching activities

Precautions

Progress resistance slowly
Avoid pain with strengthening
No sudden or jerking movements
Limit lifting to 5 pounds

Criteria for Next Phase

Near-full active range of motion
Good strength with light resistance
Functional use for daily activities

Phase 4

Progressive Strengthening

Weeks 16+

Goals

Continue to improve strength and endurance
Return to normal daily activities
Achieve maximal functional recovery

Exercises

Progressive resistance exercises
Rotator cuff strengthening program
Deltoid and periscapular strengthening
Functional and sport-specific activities as cleared
Continued stretching and mobility

Precautions

Avoid high-impact activities
Permanent lifting restrictions apply for RSA (typically 15-20 lbs)
Avoid repetitive overhead activities
No contact sports

Criteria for Next Phase

Strength 80%+ of opposite side
Pain-free daily activities
Patient satisfaction with function

Return to Activity Guidelines

Driving: 6-8 weeks (when off narcotics and safe)
Desk work: 2-4 weeks with sling
Light household activities: 6-8 weeks
Golf (putting/chipping): 3-4 months
Swimming: 4-6 months
Full golf swing: 6 months
Avoid: Contact sports, heavy lifting, repetitive overhead work

All return to activity timelines are estimates and require clearance from Dr. Joshi based on your individual progress.

Questions About Your Recovery?

Contact our office or discuss with your physical therapist if you have questions about your rehabilitation.

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