Total Shoulder, Reverse Total Shoulder and Hemiarthroplasty
Most shoulder replacements are managed similarly in the postoperative period. I prefer to refrain from NSAID (naproxen, ibuprofen, etc.) for 4-6 weeks for the sake of tendon or bone healing. I am not an advocate of early physical therapy after these surgeries. If motion is signifcantly less than expected at 3 months, PT is an option. Most shoulder replacements will feel much better and function better by 3 months post-op, but take 12-18 months for final results.
1-14 days: Sling at all times. Sponge baths only with the incision covered. Ice at least three times daily 20 minutes at a time. May remove sling for hand, wrist and elbow ROM as well as pendulum and table slides.
2-6 weeks: Sling when up and about. May remove sling when at rest and for sleep if a sound sleeper. May shower normally. Continue to ice. May resume NSAIDs if necessary. Refrain from external rotation past neutral, especially for total shoulder replacement and hemiarthroplasty to protect the subscapularis repair. May do pendulum and table slides.
5-10 weeks: May discontinue sling. May begin driving. May begin activities of daily living (self care, feeding, etc.). Limit ER 0-20 degrees. Avoid hand shaking as a greeting if right shoulder was replaced to protect the subscapularis. May start Reading Shoulder exercises especially for RTSA.
10-16 weeks: Increase activities as tolerated and ROM exercises. Limit ER to 30 degrees and do not force this. Range of motion will slowly but surely increase. May start rotator cuff strengthening exercises with therabands. Take care with lifting, keeping the elbows close to the body and using the legs to lift. Golfers can start chipping and putting at 12 weeks.
16 weeks +: Golfers may increase one club per week. Hit off of tees for all tee and fairway shots. Continue deltoid and rotator cuff strengthening.
I am very conservative in the postoperative period. My philosophy is that a shoulder replacement is first and foremost a pain relieving operation. It will improve function and ROM typically, but this is secondary. In the setting of revision shoulder replacement or RTSA for fracture, the recovery process is expected to be slower.
1-14 days: Sling at all times. Sponge baths only with the incision covered. Ice at least three times daily 20 minutes at a time. May remove sling for hand, wrist and elbow ROM as well as pendulum and table slides.
2-6 weeks: Sling when up and about. May remove sling when at rest and for sleep if a sound sleeper. May shower normally. Continue to ice. May resume NSAIDs if necessary. Refrain from external rotation past neutral, especially for total shoulder replacement and hemiarthroplasty to protect the subscapularis repair. May do pendulum and table slides.
5-10 weeks: May discontinue sling. May begin driving. May begin activities of daily living (self care, feeding, etc.). Limit ER 0-20 degrees. Avoid hand shaking as a greeting if right shoulder was replaced to protect the subscapularis. May start Reading Shoulder exercises especially for RTSA.
10-16 weeks: Increase activities as tolerated and ROM exercises. Limit ER to 30 degrees and do not force this. Range of motion will slowly but surely increase. May start rotator cuff strengthening exercises with therabands. Take care with lifting, keeping the elbows close to the body and using the legs to lift. Golfers can start chipping and putting at 12 weeks.
16 weeks +: Golfers may increase one club per week. Hit off of tees for all tee and fairway shots. Continue deltoid and rotator cuff strengthening.
I am very conservative in the postoperative period. My philosophy is that a shoulder replacement is first and foremost a pain relieving operation. It will improve function and ROM typically, but this is secondary. In the setting of revision shoulder replacement or RTSA for fracture, the recovery process is expected to be slower.