Post Operative Shoulder Replacement Rehabilitation Protocol
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This is an open procedure, and access to the Gleno-Humeral joint is typically achieved by detachment of the Subscapularis tendon or Lesser Tuberosity. This reattachment must then be protected post operatively.

General points
Improvement can continue for 18‑24 month’s post‑operatively, it is therefore important to encourage patient to continue with rehabilitation.

The aim of rehabilitation is good quality movement and maximal function.
Do not sacrifice quality of movement and function for range of movement.

Immobilisation
The patient is to wear a sling for 3 weeks, 24 hours a day, only removing for physiotherapy exercises.

At 3 weeks, the patient can be weaned out of sling but should continue to wear the sling at night for a further 3 weeks (total sling usage - 6 weeks at night).

From 0-6 weeks:
Hand, Wrist and Elbow exercises.
Pendular exercises of with gradual progression.
Active assisted elevation in supine as comfort allows.

3 weeks :
Wean out of sling – light activities only.
External Rotation to neutral as comfort allows.

6 weeks:
Start to increase External Rotation, as External Rotation increases, gradually increase elevation Range of movement.

Active assisted exercises progressing to active exercises – utilise short lever, supine & Closed Kinetic Chain if appropriate.

No long lever open chain exercises until 8 weeks

From 8 weeks:
Progress to open chain and long lever – remembering function.

Sub maximal isometrics in neutral – avoiding Subscapularis.
Consider use of the principles of the Deltoid Rehabilitation programme.

From 12 weeks:
Isometrics in variable starting positions progressing to resisted through range and strengthening.

Functional Milestones
Driving: See general principles of rehabilitation
Swimming: 3 months
Golf: 3 months
Light work/gardening: 6-8 weeks
Heavy manual work/gardening: 6 months

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