PHASE | PRECAUTIONS AND GUIDELINES | GOALS | EXERCISES | CRITERIA TO ADVANCE TO NEXT PHASE |
---|---|---|---|---|
1 (post-op day 1-2 week) | Sling 24/7 (remove for grooming and HEP-3 5x/day) Avoid hand behind back, and reaching cross body Keep arm anterior frontal plane “always see elbow” No shoulder AROM No submersion in water No weight bearing on shoulder | Protect prosthesis from dislocation Prevent infection Promote distal circulation Proper sling fit PROM: 120 elevation and 30 ER | Pendulum Active elbow, wrist and hand, scapular retraction Passive elevation to 90-120 deg in scapular plane Passive ER to 30 deg inscapular plane | Pain less than 3/10 with PROM Healing incision without signs of infection Clearance by MD after radiograph assessment at 2 week check up |
2 (3-6 wks) | Sling only in community Use of operative arm allowed for basic ADLs with elbow beside waist – nothing heavier than a coffee cup. No active reaching from shoulder May submerge in water (eg pool or hot tub) after 4 weeks Continue no shoulder extension, hand behind back, cross body or weight bearing | Passive elevation to 120; ER to 30 Able to fire all heads of deltoid Pain < 3/10 | Discontinue elbow, wrist, and hand exs since using arm of ADLs Continue pendulum, scapular retraction, PROM for elevation and ER 120/30 in scapular plane ADD: deltoid isometrics for all heads (avoid extension beyond frontal plane) Reverse pendulum at 90 deg elevation in supine | Passive elevation to 120 and ER to 30 degrees Able to fire all heads of deltoid without pain Able to place and hold arm at 90 deg in supine (balanced position) |
3 (6-12 wks) | Discontinue sling Motion recovery without excessive force Advance arm use in ADLs gradually May begin hand behind back gently NO Upper Body Ergometer due to repetitive loading of deltoid on acromion | Optimize PROM Develop AROM to match available PROM Establish dynamic stability of shoulder with deltoid and parascapular strengthening, as well as any rotator cuff remaning | Active forward elevation progression: supine to inclined to vertical, short to long lever arm (bent to straight elbow) Active ER/IR with arm at sideTheraband scapular retraction IR behind back gently | AROM when upright equals PROM in supine No pain Need higher level demand than ADL functions (eg sport or work) |
4 (12+ wks) | Avoid heavy lifting and overhead sport Avoid heavy pushing May lift light weights for deltoid but not to exceed 3 lbs NO Upper Body Ergometer | Functional demands for work and/or sport achieved Gradual increase in deltoid and parascapular muscle strength Painfree | Weights for deltoid up to 3 lbs max, using short lever arm (bent elbow) for middle deltoid raise Theraband progression for scapular muscles, including serratus anterior punches Gentle end range stretching in all planes as part of a daily lifelong routine | NA |