Total Shoulder Arthroplasty — (TSA)

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

NWB on surgical side (no pushing up from chair) Phase I; strict sling use (off only for therapy) x6 wks

Key Restrictions

Avoid active adduction, IR, shoulder extension Phase I; ER limited to neutral in scapular plane Phase I; no active IR until wk6; no heavy lifting until after wk12 (5 lb max); no sudden lifting/pushing activities Phase III

Timeline & Phases

Post-Op 0-4 wks: pain control and one-handed ADLs, gentle ROM, donning/doffing sling, protect surgical reconstruction, strict sling use (off only for therapy) x6 wks, small pillow/towel behind elbow supine to avoid hyperextension, NWB on surgical side (no pushing up from chair), avoid active adduction/IR/shoulder extension, ER limited to neutral in scapular plane, transfer/gait training with NWB on surgical side, hand/wrist/elbow ROM exercises, Codman's/pendulum exercises TID, scapular clocks, scapulothoracic mobilizations, after 4 wks initiate AAROM with T-bar/pulleys, deltoid submaximal isometrics in neutral, grade I-II shoulder joint mobilizations, walking with sling on; progress to Phase II after 6 wks with pain-free PROM; Phase II (4-8 wks): sling strict x6 wks, minimize pain, optimize shoulder strength, target FROM by wk8, no active IR until wk6, progress PROM, initiate PROM of IR to tolerance (not exceeding 50 deg) in scapular plane, AROM progressing to light deltoid/biceps/triceps strengthening, isometrics progressing to TheraBands, light bent-over rows, light serratus punches, light side-lying ER, at wk6 progress ER stretching under tension (no pain) and IR on light pulleys, walking/Stairmaster/stationary bike; Phase III (8-24 wks): progress functional strength/endurance, no heavy lifting until after wk12 (5 lb max), no sudden lifting/pushing, add PREs with no restrictions, side-lying ER or light band ER for RTC strengthening, initiate IR strengthening (isometrics progressing to isotonics), begin gentle extension beyond neutral and IR up the back, begin functional progression for sports/activity-related tasks

Notes

OSMS Rehabilitation Guidelines; also applies to shoulder hemiarthroplasty for fracture/rotator cuff damage indications; recommends pre-op planning to arrange help around the home for ADLs; references Brown & Friedman (Orthop Clin North Am 1998) and Wilcox/Arslanian/Millett (JOSPT 2005)