Anatomic Total Shoulder

Weeks 0-1:

• Patient to do Home Exercises given post-op (pendulums, elbow ROM, wrist ROM, grip strengthening)

Weeks 1-6:

• Sling for 4 weeks. Abduction pillow can be discontinued after 2 weeks.
• PROM > AAROM > AROM as tolerated, except ...
  • No active IR/backwards extension for 6 weeks. The subscapularis tendon is taken down for the surgery and then repaired afterwards. It takes about 4-6 weeks for it to grown back into the humerus and regenerate a blood and nerve supply.
• ROM goals: Week 1: 90° FF /20° ER at side; ABD max 75° without rotation
• ROM goals: Week 2: 120° FF/40° ER at side; ABD max 75° without rotation
• No resisted internal rotation/backward extension until 12 weeks post-op
• Grip strengthening OK
• Canes/pulleys OK if advancing from PROM
• Heat before PT, ice after PT

Weeks 6-12:

• Begin AAROM - AROM for internal rotation and backwards extension as tolerated, if not already begun.
• Goals: Increase ROM as tolerated with gentle passive stretching at end ranges
• Begin light resisted ER/FF/ABD: isometrics and bands, concentric motions only
• No resisted internal rotation/backwards extension until 12 weeks post-op
• No scapular retractions with bands yet

Months 3-12:

• Begin resisted IR/BE (isometrics/bands): isometrics > light bands > weights
• Advance strengthening as tolerated; 10 reps/I set per exercise for rotator cuff, deltoid, and scapular stabilizers.
• Increase ROM to full with passive stretching at end ranges
• Begin eccentric motions, plyometrics, and closed chain exercises at 12 weeks.