Shoulder Arthroplasty Protocol
Phase I: (weeks 0-6)
Precautions: Sling immobilization for 6 weeks except for bathing and therapeutic exercises Goals: Pain and edema control; patient education; ROM; initiate HEP
Treatment Strategies:
• passive pendulum exercises
• Scapulothoracic mobilization
• Passive supine forward flexion (limit 130° for first 3 weeks, then advance to tolerance)
• initiate table slides at week 2.
• Assisted supine forward flexion
• Passive and assisted external rotation (limit to 25° for first 3 weeks and then advance to tolerance)
• Assisted extension
• Deltoid isometrics
• Distal active ROM exercises (elbow, wrist and hand)
Phase II: (weeks 6-12)
Precautions: Sling may be discontinued at 6 weeks
Goals: Advance PROM in all planes; begin active ROM; advance to independent HEP Treatment Strategies:
• Active supine forward flexion with elbow flexed
• Active forward flexion raising arm from table top
• Gradual increase of activities from supine to vertical position
• Progress to active flexion, extension, abduction, and internal rotation
• Begin active internal rotation
• Gradual increase of active ROM exercises
• Closed kinetic chain exercises
• Theraband exercises for flexion, extension, external rotation
• Light resistive exercises
Phase III: (week 12+)
Goals: Advance end range PROM/AROM; restore normal scapulothoracic rhythm; advance muscle strength; transition to independent HEP
Treatment Strategies:
• Progress ROM as tolerated
• Flexibility exercises
• Isometrics
• Increase resistive exercises
• Include light weights, advance as tolerated
• Progress to full independence with ADL and functional muscle strength and coordination