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Total shoulder replacement or hemiarthroplasty or resurfacing with tuberosities intact
Considerations for physiotherapy

Subscapularis is released and reattached therefore it is important to protect this repair by avoiding external rotation and resisted internal rotation in the early stages of healing. Stiffness must be prevented by early mobilisation that respects the limitations required to protect the subscapularis repair. Atrophy of the muscles is likely in patients who have experienced prolonged pain and disuse prior to surgery and rehab is therefore likely to be slow.



Teach elbow,radioulnar, wrist and hand maintenance exercises.

Teach pendular exercises

Explain post op protocol


Day 1

Polysling and body belt to maintain shoulder in adduction and internal rotation

Elbow, radioulnar, wrist and hand maintenance exercises

Pendular exercises

Passive flexion and passive abduction in internal rotation

Progress to active assisted exercises over first week to ten days as pain allows

Avoid external rotation beyond neutral

At 2 weeks

Isometric exercises avoiding internal rotation

Continue active assisted exercises

At 4-6 weeks

Start to wean from sling and encourage gentle ADL

Active movements except for internal rotation

Start stretching avoiding external rotation beyond neutral

At 6 weeks

Start active internal rotation

Regain active range of external rotation

Resisted deltoid and external rotators

Continue stretching to end of range

After 8 weeks

Unrestricted arm use


Written by Clare Connor MCSP and Claire Kellaway

Review date: October 2003






Shoulder Conditions

Elbow Conditons