Anatomic Total Shoulder Arthroplasty (Traditional)

Physical Therapy Protocol

Phase I – Immediate Post-Op (0–3 Weeks)

Goals:

• Protect surgical repair
• Reduce swelling and minimize pain
• Maintain elbow, wrist, and hand mobility
• Gradually increase shoulder PROM
• Minimize muscle inhibition
• Educate patient

Precautions / Restrictions:

• Sling in neutral rotation with abduction pillow (30–45°); worn at night
• No shoulder AROM
• No reaching behind back or internal rotation
• Avoid excessive ER or abduction
• No lifting or weight-bearing through arms
• Place pillow/towel under elbow when supine

Therapeutic Exercises:

• PROM: ER ≤30° (scapular plane), IR to beltline, Flexion/scaption to tolerance, Abduction ≤90°, Pendulums, Table slides
• AAROM: Active-assisted flexion
• AROM: Elbow, wrist, hand
• Periscapular (from Week 2): Scapular retraction, Prone retraction, Supported setting, Inferior glide, Low rows
• Ball squeezes

Criteria to Progress:

• PROM flexion/scaption ≥50% of contralateral side
• Abduction PROM ≤90°
• ER PROM ≤30°
• IR PROM ≥70°
• Pain < 4/10, no complications

Phase II – Intermediate Post-Op (Weeks 4–6)

Goals:

• Continue protecting repair
• Increase PROM
• Initiate AROM & AAROM with minimal substitutions
• Improve periscapular control
• Begin rotator cuff (ER) activation

Precautions / Restrictions:

• Sling only at night; begin weaning during day
• No lifting > coffee cup
• No weight-bearing through arms
• Avoid shoulder hyperextension when supine

Therapeutic Exercises:

• Continue Phase I activities
• PROM: Full ROM except ER ≤30°, ABD ≤90°
• AAROM: Cane flexion/ER, Washcloth press, Cane elevation
• AROM: Supine flexion, Salutes, Supine punches
• Strengthening: ER isometrics, Ball rows, Serratus punches, Band curls & triceps
• Motor Control: Rhythmic stabilization (ER/flexion 90–125°)
• Stretching: Sidelying horizontal adduction

Criteria to Progress:

• PROM ≥75% of contralateral side
• ER PROM = 30°, ABD PROM = 90°
• Minimal substitution patterns
• AROM elevation ≥100°
• Pain < 4/10, no complications

Phase III – Advanced Intermediate (Weeks 7–8)

Goals:

• Protect anterior capsule
• Improve AROM
• Advance strengthening
• Normalize scapular control
• Return to functional activity

Precautions:

• No lifting >10 lbs

Therapeutic Exercises:

• Continue prior phases
• AAROM/AROM: Table slides, Wall ball rolls, Wall climbs, Pulleys, Seated scaption/flexion, Supine resisted elevation
• Strengthening: Side-lying ER, Resistance band ER/IR, Rows, Lawn mowers, Robbery rows
• Motor Control: Quadruped stabilization, PNF D1/D2 lifts
• Stretching: IR with towel, Sidelying horizontal adduction, Sleeper stretch, Triceps/lats

Criteria to Progress:

• Minimal to no substitution patterns
• Pain < 4/10

Phase IV – Transitional Phase (Weeks 9–11)

Goals:

• Maintain pain-free PROM
• Improve AROM
• Advance dynamic shoulder stability
• Restore shoulder strength and endurance

Precautions:

• No lifting >10 lbs
• Avoid ER >80° abduction

Therapeutic Exercises:

• Continue previous interventions
• Strengthening: Higher resistance for RC and scapular muscles, Push-up plus (knees), “W”s, Dynamic hug, Tripod holds
• Motor Control: PNF with resistance, Wall slides with resistance band

Criteria to Progress:

• Supine AROM Flex ≥140°, ABD ≥120°, ER ≥60°, IR ≥70°
• Elevation ≥120° with good mechanics
• Pain < 2/10

Phase V – Advanced Strengthening (Weeks 12–16)

Goals:

• Maintain full, pain-free ROM
• Optimize strength and endurance
• Return to recreational and ADL activities

Therapeutic Exercises:

• Continue all prior exercises
• Strengthening: ER/IR at 90° abduction, “T” and “Y” exercises, Push-ups (wall/floor)
• Motor Control: Overhead rhythmic isometrics, Ball stabilization overhead

Criteria for Full Return:

• Surgeon clearance
• Full pain-free ROM
• Symmetric scapular mechanics
• QuickDASH or PENN outcome scores documented