PHYSICAL THERAPY PRESCRIPTION:   
 
TOTAL SHOULDER ARTHROPLASTY 
 
Weeks 2-6: Phase I 
 
Sling Immobilizer: At all times except for showering and exercise. (Sleep in sofa recliner) 
 
 
       Total of 6 weeks in the Sling and the Abduction pillow 
 
Exercises: 
Pendulums ok 2 weeks after surgery 
Passive ER to 10 degrees and extension to neutral 
 
 
Passive supine FF in scapular plane to 130 (NO aggressive stretching and NO PAIN) 
 
 
AROM wrist/elbow  
 
 
Submax (50%) pain free deltoid isometics in neutral 
 
 
Scapular “pinches”  
 
 
Modalities as needed 
 
Advancement Criteria: ER the above set criteria 
  FF in scapular plane to 130 
  Minimal pain and inflammation with motion and exercise 
  Incision is well healed with no drainage and no redness 
  
Weeks 6-10: Phase II 
 
Sling Immobilizer: Discontinue at week 6 
 
Exercises:  
Passive & Active assisted FF in scapular plane – no limits (wand exercises, pulleys)  
 
 
Passive & Active assisted ER – limit 45 deg 
 
2 
 
 
Active supine FF in scapular plane 
    
 
Manual scapular side-lying stabilization exercises 
 
 
Isometrics: Deltoid in neutral 
 
 
 
       ER (modified neutral) ROM < 30 deg 
 
 
 
       IR (modified neutral)  
 
 
Scapular retraction with elastic bands 
 
 
Humeral head control exercises: 
 
 
 
       ER/IR (supine/scapular plane) 
 
 
 
       Elevation at 100 deg 
 
 
Modalities as needed 
 
Advancement Criteria: FF to 150 
 
 
 
 ER to 45 
 
 
 
 Good humeral head control  
 
 
 
 Minimal to no pain with ADLs 
 
Weeks 10-16: Phase III 
 
Exercises:  
Progress ROM as tolerated 
 
 
AAROM for full FF and ER 
AAROM for IR – no limits 
Flexibility exercises: towel stretch, posterior capsule stretch 
 
 
 
IR/ER/FF isotonic strengthening  
Scapular stabilization 
 
 
Rhythmic stabilization 
 
 
PREs for scapula, elbow (biceps/triceps) 
 
 
Forward flexion in scapular plane 
 
 
Progressive resistive equipment: row, chest press (light weight) 
Modalities as needed 
 
 
Advancement Criteria: Muscle strength 4/5 
 
 
 
 Passive FF 160, ER >45 
 
 
 
 Restore normal scapulohumeral rhythm <90 deg elevation 
             Minimal pain and inflammation   
 
Weeks 16-22: Phase IV 
 
Exercises:  
Access and address any remaining deficits in ROM, flexibility, strength 
 
 
Active, active-assisted, and passive ROM exercises 
 
 
Flexibility exercises: towel stretch (IR), posterior capsule stretch 
 
 
 
Progressive resistive strengthening: 
 
 
 
 
Dumbbells 
 
 
 
 
Progressive resistive equipment 
 
 
 
 
Elastic band IR/ER (modified neurtral) 
 
 
Rhythmic stabilization 
 
 
Modalities as needed 
 
 
Individualize program to meet specific needs of patient 
 
 
 
 
 
3 
Discharge Criteria: Maximize ROM 
 
          Full independent ADLs 
 
          Normal scapulohumeral rhythm >100deg elevation  
 
