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Physical Therapy After A Shoulder Replacement

If you have been told by your physician that you need a total shoulder replacement you are probably wondering what the recovery process is. The first thing you should know is that no matter how much pain you are feeling in your shoulder now, you will be very pleasantly surprised at how little pain you feel after the surgery. The reason for this is that most shoulder replacement candidates are people who have severe arthritis in the joint, significant fractures near the joint, badly damaged/torn soft tissues in the joint, or tumors in the area, all of which cause a great deal of pain. After the shoulder replacement, the source of pain is usually completely eliminated.

It is important to note that there are two different types of shoulder replacements – standard and reverse – and your recovery process will be determined by the type of procedure you had and which muscles were cut and reattached during the procedure. After the operation, your surgeon will most likely request that you go through a course of skilled physical therapy to regain as much shoulder motion and strength as possible in order to maximize function. With both types of procedures you will go through three phases of rehabilitation. The length of each phase will be determined by your surgeon as will the guidelines you follow during each phase.

PHASE I: Protection

During phase I you will be wearing a sling to protect the replaced joint and surrounding capsule and muscles. Most surgeons will require you to wear the sling at all times (including at night while sleeping) for about 4-6 weeks and will instruct you to avoid moving your shoulder, leaning on your elbow or hand, lifting > 0.5 lbs, pushing objects, and pulling anything in toward your body. You will, however, be allowed to perform simple activities with the surgical arm like typing, writing, and eating, and you may be instructed by your surgeon to perform ROM exercises for your elbow and wrist.

PHASE II: Passive Range of Motion (ROM)/Active Assisted ROM/Active ROM

Phase II usually begins only after the sling has been discharged in order to protect the tissues that had to be cut during the surgical procedure. During this phase you will be referred to a physical therapist to start regaining shoulder motion. It is very important that you follow through with skilled physical therapy during phase II to prevent permanent shoulder stiffness. Your course of therapy will include manual/passive ROM by your therapist as well as active assisted (moving your arm with some help) and active ROM (moving your arm on your own with no assistance).

PHASE III: Strength

At about 10-12 weeks post op, you will enter into phase III, during which your physical therapist will slowly begin strengthening all the muscles in your arm, especially the muscles around your shoulder and shoulder blade. This phase is crucial to restoring premorbid function, because you can have good motion, but without strength, you may not be able to perform the activities you were able to execute before the surgery. After 12 weeks you should have no restrictions and as long as you keep up with the home exercises given to you by your physical therapist, you will show progress for up to a year.

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