Total Shoulder Arthroplasty — Anatomic (TSA)

Saint Louis University (SLUCare) · SSM Health PT Orthopedic Residency

Weight-Bearing

N/A

Key Restrictions

Sling at all times wks 0-2; limit passive ER to 30 deg wks 2-6; limit passive FF and IR to scapular plane wks 2-6; PNF and isotonics in supported position only until wk 12; uses Soreness Rules for exercise intensity

Timeline & Phases

Wks 0-2: HEP sling at all times, AROM cervical/elbow/wrist/hand 3x/day; Wks 2-6: PROM (ER limit 30 deg, FF to scapular plane, IR to scapular plane), scar mob, MLD for edema, scapular retraction, aerobic conditioning; milestone: passive ER 30 deg, passive FF 130 deg, DC sling; Wks 6-10: passive and AAROM (wall slides, wand, pulleys), gentle ER beyond 30 deg, AROM supine FF, scapular stabilization, isometrics (deltoid, ER, IR in modified neutral), aerobic + UBE; milestone: passive FF 150 deg, ER 60 deg, active supine FF 90 deg/ER 45 deg; Wks 10-16: progress ROM, flexibility into extension and IR, PNF, isotonic axioscapular emphasis (scapular rows), PNF supported until wk 12; milestone: axioscapular 4/5 MMT, optimal scapulohumeral rhythm to 90 deg; Wks 16+: flexibility (towel stretch, posterior capsule stretch), progressive resistive strengthening (dumbbells, bands, elastic IR/ER); discharge: full ROM, independent ADLs, optimal scapulohumeral rhythm >120 deg

Notes

SLU/SSM Health PT Orthopedic Residency; Dr. Scott Kaar and Dr. Christopher Kim; evidence-based with 16 references; uses Soreness Rules (Fees et al. 1998); covers anatomic TSA only (not reverse); last updated 10.31.2019; ~4-month protocol 1-3 visits/week

Surgeon / Author

SSM Health PT Orthopedic Residency

Published

2019