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Total Shoulder Arthroplasty Rehab Protocol

Total Shoulder Arthroplasty/Hemiarthroplasty- Brigham and Women's Hospital

Phase I: Immediate Post-Surgical Phase

  • Goals: Reduce pain, inflammation and muscular inhibition, increase PROM of shoulder, allow healing of soft tissue
  • Precautions: Sling worn continuously for 3-4 weeks, no shoulder AROM, no lifting of objects 
  • Exercises:
    • Early Phase 1: Passive forward flexion, ER, and IR in scapular plane, pendulum exercises, and AROM of distal extremity
    • Late Phase 1: Continue above exercises, scapular isometrics, AAROM of shoulder flexion, ER, and IR in scapular plane 
  • Criteria to progress to Phase II: Tolerates PROM, at least 90° PROM forward flexion and elevation, 45° PROM ER, and 70° PROM IR in scapular plane

Phase II: Early Strengthening Phase

*Do not begin within 4-6 weeks post surgery for appropriate soft tissue healing

  • Goals: Restore full PROM, gradually restore AROM, control pain and inflammation
  • Precautions: Sling only to be worn while sleeping, no lifting of objects heavier than a coffee cup, no sudden movements, pillow to be placed under elbow when in supine
  • Exercises: Begin flexion, IR, ER, and elevation in scapular plane, sub-maximal pain-free shoulder isometrics in neutral, progress scapular and distal extremity strengthening exercises, gentle glenohumeral/scapulothoracic mobilizations
  • Criteria to move to Phase III: Tolerates P/AAROM/isometric exercises, has at least 140° PROM of forward flexion, 60° PROM ER, and 70° PROM IR in scapular plane, achieves 100° AROM of shoulder elevation against gravity w/ good mechanics

Phase III: Moderate Strengthening

*Not to begin within 6 weeks post-surgery for appropriate soft tissue healing

  • Goals: Gradual increase in strength, power, endurance, and functional mobility
  • Precautions: No heavy lifting beyond 6 lbs, no sudden movements
  • Exercises: Progress above exercises, begin resisted flexion, elevation, IR and ER exercises in scapular plane, light functional activities, wean from sling completely, AAROM IR behind back, 
  • Criteria to move to Phase IV: Tolerates AA/AROM/strengthening exercises, has at least 140° AROM forward flexion, 60° AROM ER, and 70° AROM IR in scapular plane, able to activiely elevate shoulder against gravity to at least 120° with good mechanics 

Phase IV: Advanced Strengthening

*Not to begin before 12 weeks post-surgery for appropriate soft tissue healing

  • Goals: Maintain non-painful AROM, increase functional use of UE
  • Precautions: Avoid exercises and activities that place stress on anterior capsule
  • Exercises:
    • Early Phase IV: Progress strengthening program, gradual return to moderately challenging functional activities
    • Late Phase IV (generally 4-6 months post-op): Return to recreational activities
  • Criteria for d/c: Non-painful AROM, maximized strength, power, endurance, and functional ability



Total Shoulder Arthroplasty/Hemiarthroplasty Protocol. Brigham and Women's Hospital Web site.