The Physical Therapy Process After Total Shoulder Replacement Surgery

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Surgery and trauma can limit mobility and quality of life. Physical therapists are experts  in human anatomy and biomechanics and are specifically trained to restart mobility, strength, and quality of life following surgery. One such surgery is total shoulder replacement, but with physical therapy, surgery outcomes can be excellent.

Shoulder replacement surgery was initially used to treat severe shoulder fractures, but over the years, refinement of the process and improved technology have now allowed doctors to use the surgery for other painful shoulder conditions, such as arthritis.

There are several forms of arthritis, which include osteoarthritis, normal wear and tear, and multiple forms of rheumatoid arthritis caused by an abnormal inflammatory response. Shoulder arthritis causes pain and stiffness in the joint and reduces range of motion. It is caused when cartilage starts to wear down between the ball and socket of the shoulder.

Total shoulder replacement surgery involves removing the ends of the upper part of the arm that is shaped like a ball and the part of the shoulder blade that it fits into, and replacing them with metal and plastic implants. It also involves cutting through a muscle which must heal before serious recovery can take place.

Brian Richardson, PT, SCS, CSCS is a licensed Physical Therapist and Sports Certified Specialist for Bone and Joint Rehabilitation Services. He received his Bachelor of Science degree in Physical Therapy from the University of Tennessee Health Science Center in Memphis and a Master of Science in Exercise Science from Middle Tennessee State University. He has received many additional certifications, and he has co-authored a chapter in “Essentials of Physical Medicine and Rehabilitation” on upper extremity rehabilitation including shoulder replacement rehabilitation. Here he shares his knowledge of the physical therapy process after total shoulder replacement surgery.

Williamson Source: Total shoulder replacement surgery is an invasive surgery that results in placement of a prosthetic implant. How long after the surgery does physical therapy begin? 

Brian Richardson: Typically, a patient will start physical therapy about two to three days after their surgery. We begin slowly with pendulum swings, elbow and gripping exercises, and work within the pain free range of motion.

WS: After the surgery the shoulder is totally immobilized in a shoulder sling, how long does a patient remain in a sling?

Richardson: The sling must be worn for at least six weeks. After three to four days the patient will be able to remove the sling to shower and do light desk work at a computer, however they must wear the sling at night and whenever they go out.

WS: What will patients do during the first several months of physical therapy?

Richardson: Initially, the goal of physical therapy is to decrease pain and inflammation in the shoulder following the surgery and to start early motion of the wrist, hand, elbow and shoulder. During the first month, we will focus on passive range of motion of the shoulder, where the physical therapist moves the shoulder for the patient and active assistive range of motion exercises.

Next, we begin to work on active range of motion of the shoulder as well as strengthening exercises of the shoulder. The goal of these exercises is to gain range of motion in the shoulder. In doing so, this will allow the patient to begin performing their activities of daily living. We also begin working on strengthening exercises for the rotator cuff and muscles that stabilize the scapula or shoulder blade.

Lastly, our goal is to gain motion back in the shoulder in order for the patient to reach overhead and to perform more activities of daily living.  We continue to progress rotator cuff strengthening as well as strengthening exercises that stabilize the scapula.  We also begin closed chain activities of the upper extremity. Closed chain exercises for the upper extremity include exercises where the hand is fixed against an object and cannot move such as when one performs pushups.

WS: How long until they will have full range of motion, and shoulder usage will be back to normal? 

Richardson: By the end of three or four months, our goal will be that they have full range of motion. They will be performing a strengthening program focused on using light weights and resistance bands to slowly build it back. If the patient is still lacking motion in their shoulder, we will continue to address those deficits with shoulder stretches.

A total shoulder replacement patient will be in rehab for about four to six months and then transition to a home program where they will perform their exercises independently for the next several months.

WS: So, you work with each patient individually on reaching goals in their recovery?

Richardson: We get to know each patient and learn how they’re motivated and what they want to get back to doing on a daily basis. We tailor a treatment plan that is individualized to the patient and their overall goals. Some are very self-motivated, others need a little encouragement. No two people recover the same way.

Once they are discharged from physical therapy, it will be important for the patient to continue with a home exercise program.  These exercises may include stretches for the shoulder and strengthening exercises for the shoulder and the scapular muscles.

We encourage patients to continue with an exercise program after they are discharged from formal physical therapy so they can continue to improve their overall mobility and strength of their shoulder in order to return to activities that they enjoyed prior to their shoulder injury and subsequent surgery.

WS: I understand that a Bone and Joint Institute patient can now take total shoulder replacement physical therapy at a new clinic in Brentwood?

Richardson: Bone and Joint Institute has continued to grow and we have expanded to help serve our patients in the Brentwood area.  We opened a clinic at 101 Creekside Crossing in Maryland Farms in December 2021. The clinic offers physical therapy on one side and Orthopedic Urgent Care on the other. At this clinic, we have three physical therapists and one physical therapist assistant. We have similar clinics in Nolensville and Thompson Station.

If you are suffering from shoulder pain, contact Bone and Joint Institute.

To learn more about recovery from total shoulder replacement rehabilitation and shoulder care, contact Brian Richardson, PT, SCS, CSCS, or any of our Rehabilitation Services team in Brentwood at 615-791-2391.