Adam Seidl, MD - Board Certified Orthopaedic Surgeon - Shoulder and Elbow Specialist

Adam Seidl, MDBoard Certified Orthopaedic SurgeonShoulder and Elbow Specialist

Shoulder Arthroplasty

Phase 1: Hospital to 1st Follow up – Protect Subscapularis (0 to 2 weeks)

  • Patients may shower immediately over clear plastic, waterproof dressing
  • Waterproof (tegaderm) dressing will be removed by surgeon at 1stpost-op visit
  • Sutures are all underneath the skin and will dissolve on their own
  • Sling should be worn at all times with the exception of showering and while performing shoulder exercises
  • While lying supine, the distal humerus/elbow should be supported by a pillow or towel roll to avoid shoulder extension
  • Therapist should teach the following in hospital on POD1 to be performed 3 times per day starting immediately:
    • Elbow, forearm, and hand AROM
    • Supine passive ROM – flexion to 130, ER to 20 – See Handout

      Supine exercises should be performed with a small towel placed behind the elbow to avoid shoulder hyperextension and anterior capsular stretch

    • Emphasize home program

Phase 2: Protect the Subscapularis(2 to 6 weeks)

  • Sling should be worn at night and when out of house. May remove the sling during the day with the following restrictions:
    • Limit ER to 20
    • No resisted IR
    • Avoid extension of shoulder
    • Avoid reaching behind the back
    • Do not lift anything greater than 2 to 3 lbs with the involved hand
    • While lying supine, the distal humerus/elbow should be supported by a pillow or towel roll to avoid shoulder extension
  • Continue Phase 1 exercises with the addition of:
    • Pendulums
    • AAROM - Pulleys into scapular plane elevation to 130, ER to 20
    • Supine AAROM into flexion and ER with above limits
    • Emphasize home program

Phase 3: (6 weeks -10 weeks)

  • Discontinue sling use
  • Lifting restriction of 10 pounds remains
  • Advance AROM and PROM as tolerated
    • Maintain ER limit of 30 until 10 weeks.
    • Advance elevation as tolerated
  • Scapular stabilizer strengthening.
  • Strengthen rotator cuff and shoulder musculature (Isometrics, Theraband, dumbbell, etc).  AVOID RESISTED IR OR EXTENSION UNTIL 10 WEEKS.

Phase 4: (>10 weeks)

  • Advance shoulder ER range of motion as tolerated (Light stretching only).
  • May initiate subscapularis strengthening (resisted IR and extension).
  • Advance shoulder and rotator cuff strengthening as tolerated.
  • Incorporate low level functional activities at 3 months (swimming, water aerobics, light tennis, jogging)
  • Start higher-level activities at 4 months (tennis, light weight training, and golf).
  • Initiate functional progression to sports specific activities at 4 months.

Reverse Shoulder Arthroplasty for Chronic Dislocation

Phase I: Protect the Repair (0 to 6 weeks)

  • Staples to be removed at 14 days after surgery
  • Sling/immobilizer should be worn AT ALL TIMES other than when showering
  • Initiate exercise program 3 times per day immediately:
  • Immediate elbow, forearm and hand AROM
  • Pendulums may begin at 2 weeks after instruction by therapist
  • Passive Supine ROM to 90 degrees FE and 20 degrees ER.

Phase II: PROM/AAROM (6 to 8 weeks)

  • Discontinue sling at all times
  • Lifting restriction of 2-3 pounds
  • Advance AAROM and PROM as tolerated
  • Maintain ER limit of 30 until 8 weeks.
  • Advance forward elevation as tolerated
  • Scapular stabilizer strengthening.

Phase III: AROM/Strengthening (>8 weeks)

  • Advance AROM as tolerated
  • Strengthen rotator cuff and shoulder musculature (Isometrics, Theraband, dumbbell, etc).  AVOID RESISTED IR OR EXTENSION UNTIL 10 WEEKS.
  • Lifting restriction of 10 pounds until 3 months
  • Incorporate low level functional activities at 3 months (swimming, water aerobics, light tennis, jogging)
  • Start higher level activities at 4 months (tennis, light weight training, and golf).
  • Initiate functional progression to sports specific activities at 4 months.

Reverse Shoulder Arthroplasty for Fracture

Phase I: Protect the Tuberosity (Rotator Cuff) Repair (0 to 6 weeks)

  • Staples to be removed at 14 days after surgery
  • Sling/immobilizer should be worn AT ALL TIMES other than when showering
  • Initiate exercise program 3 times per day immediately:
  • Immediate elbow, forearm and hand AROM
  • Pendulums may begin at 2 weeks after instruction by therapist

Phase II: PROM/AAROM (6 to 8 weeks)

  • Discontinue sling at all times
  • Lifting restriction of 2-3 pounds
  • Advance AAROM and PROM as tolerated
  • Maintain ER limit of 30 until 8 weeks.
  • Advance forward elevation as tolerated
  • Scapular stabilizer strengthening.

Phase III: AROM/Strengthening (>8 weeks)

  • Advance AROM as tolerated
  • Strengthen rotator cuff and shoulder musculature (Isometrics, Theraband, dumbbell, etc).  AVOID RESISTED IR OR EXTENSION UNTIL 10 WEEKS.
  • Lifting restriction of 10 pounds until 3 months
  • Incorporate low level functional activities at 3 months (swimming, water aerobics, light tennis, jogging)
  • Start higher level activities at 4 months (tennis, light weight training, and golf).
  • Initiate functional progression to sports specific activities at 4 months.

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Location Map

  • Orthopedics - University of Colorado Hospital

    1635 Aurora Ct
    4th Floor
    Aurora, CO 80045

  • UCHealth Lone Tree Clinic

    9548 Park Meadows Dr
    Lone Tree, CO 80124

Credibility Logos

  • The American Board of Orthopaedic Surgery logo
  • American Academy of Orthopedic Surgeons logo
  • American Shoulder And Elbow Surgeons logo
  • Western Orthopaedic Association logo
  • Alpha Omega Alpha
  • Moon Shoulder