Having total shoulder replacement surgery is a complex operation that can take up to six months to heal completely. You start rehabilitation almost immediately, focusing on reducing stiffness and pain. As you recover, you progress through four phases of recovery.
Before we describe what you can expect while you recover from total shoulder arthroplasty, we want to remind you that passive range of motion (PROM) movements should only be carried out by a trained physical therapist. It is not stretching, and you should not undertake any movements or stretching on your own until your surgeon and therapist agree that it is safe.
Phase 1 – Immediate Post Surgical
Phase 1 includes the first four weeks of your recovery. During your rehabilitative physical therapy, you focus on decreasing pain and inflammation and increasing your passive range of motion. Your physical therapist educates you about protecting your shoulder and how to safely return to independence and activities of daily living (ADL).
- Wear your sling all day and night
- When lying on your back, place a small pillow under your elbow to avoid hyperextension — you should always be able to see your elbow while you lie on your back
- Avoid hyperextending your arm or using your shoulder
- Do not lift anything
- Do not move your arm behind your back
- Do not support your body with your arms or hand
- Do not rotate your arm
- Keep your incision clean and dry
- Apply an ice pack for 15-20 minutes every hour
Your physical therapy during phase one includes movements to reduce swelling and improve your passive range of motion. For example, you will work on:
- Passive forward flexion in supine — this means that while you lie on your back, your physical therapist gently lifts your arm, eventually reaching a 90-degree angle by the end of the second week.
- Pendulums — your therapist will move your arm in small circles
- Submaximal isometric shoulder exercises — while keeping your shoulder in a neutral position, your therapist helps you build strength with static holds
- Isometric exercises to strengthen the muscles around your shoulder blade
- Introduce pulley exercises around the third week
- Exercises and stretches for your hand, wrist, and elbow
Phase 2 – Early Strengthening
Phase two includes weeks four through six. During this phase, your physical therapist continues your passive range of motion exercises until your full range of motion is restored.
They also introduce active assistive range of motion exercises. You continue to use ice packs to reduce inflammation and pain and take the same precautions that you used in the first four weeks to avoid overstressing your shoulder while establishing stability and mobility.
During physical therapy, you will continue to practice passive range of motion movements, active assistive range of motion exercises, and isometric holds. You also continue to work on your scapular strengthening and hand, wrist, and elbow exercises.
During phase four, you also begin to work on:
- Assisted horizontal adduction — your therapist moves your arm across your chest and abdomen at different angles
- Gentle joint mobilizations — small, controlled assisted movements to increase your range of motion in several directions
- Rhythmic stabilization — small rhythmic movements to increase stability
- Active (you move your own arm) forward flexion and internal and external rotations
- Isometric holds to strengthen your rotator cuff and periscapular muscles (small muscles that extend from your shoulder blade toward your spine
Phase 3 – Moderate Strengthening
Phase three lasts through weeks 6-12. Your goals are to achieve a full passive range of motion in all directions, the gradual restoration of your shoulder strength, power, and endurance, increased rotations, and progressive return to your activities of daily living.
Usually, by week 6, you can stop wearing your sling, but don’t stop wearing it until your surgeon says it’s safe to do so. While your range of motion and strength are returning, you should avoid lifting anything heavier than five pounds and avoid any sudden lifting, pushing, or jerking activities.
During phase three, your physical therapist works with you to practice:
- Anti-gravity internal and external rotations and abduction — you lift your own arm to rotate it and move it across your body
- Increase your range of external rotation
- Begin assisted internal rotations behind your back
- Flexion, external rotations, and abduction movements with gentle resistance
- Progress behind the back internal rotations from active assistive range of motion to your full independent range of motion
Phase 4 – Advanced Strengthening
Phase 4 lasts from 12 weeks to six months. Your goals during this final phase of recovery from your shoulder replacement include:
- Maintaining full non-painful range of motion
- Gradual return to advanced functional activities like reaching for objects above your head
- Improving your muscular strength, power, and endurance
You should continue to take precautions to protect your shoulder, such as avoiding movements that put too much stress on your shoulder or overextend your joint.
You may continue to have less frequent physical therapy appointments but will work on the daily exercises and movements in your home exercise program. You will also return to your regular hobbies and can get back to any sports when your surgeon says it’s safe to do so.
In order to be discharged from physical therapy, you need to be able to maintain your full active range of motion without pain and perform all of your regular daily activities.