Total Shoulder Arthroplasty — (TSA)

University Hospitals · Christopher LeVan, PT; John Campolieti, PT; Jeffrey Daniel Chelette, PT; Alison…

Weight-Bearing

Non-weight bearing through affected UE; sling worn (except during exercise) 4-6 wks per surgeon discretion

Key Restrictions

No AROM, no IR/extension past neutral, no reaching behind back, PROM limited to 90 deg flexion/30 deg ER scapular plane x2wks (Phase I); avoid active IR/extension, limit ER to 45 deg at side, avoid ER at 90 deg abduction, passive elevation to 120 deg scapular plane, no lifting >1-2 lbs (Phase II, 2-6wks); no resisted IR x12wks, no extension past neutral, passive ER not to exceed 60 deg, no aggressive stretching (esp. IR behind back), no lifting >5lbs (Phase III, 6-12wks); subscapularis and/or long head of biceps repair may warrant additional protection - review operative notes

Timeline & Phases

Phase I (0-2wks): protect implant/subscapularis, pain/swelling control, maintain cervical/elbow/wrist mobility, gradual PROM; Phase II (2-6wks): D/C sling per surgeon, progress PROM/AAROM, submax isometrics, regain ADL independence; Phase III (6-12wks): AAROM to AROM progression, scapular/deltoid strengthening, wean sling, goal ~120 deg active flexion/~60 deg ER/IR to sacrum; Phase IV (12wks+): return to lifting and low-to-moderate-impact recreational activity, IR strengthening, closed-chain exercises, goal ~150 deg flexion, physician clearance required for moderate-impact activities

Notes

Outcome measures: QuickDASH, PSFS; high-impact/contact sports and heavy overhead lifting generally not recommended; discharge (athletic) criteria: >90% strength vs. uninvolved UE, MD clearance, simulate recreational activities; discharge (non-athletic): pain-free ADLs; extensive references

Surgeon / Author

Christopher LeVan, PT; John Campolieti, PT; Jeffrey Daniel Chelette, PT; Alison Ives, PT (reviewed January 2025 by Mario Gastaldo, PT; physician review February 2025: Daniel Zanotti, MD, Robert Zanotti, MD, Brian Victoroff, MD, Jacob Calcei, MD, John Martin Leland, MD)

Published

2025-02