Physical Therapy Exercise After a Total Shoulder Replacement

Exercises for Recovery From Total Shoulder Replacement

If you have had a total shoulder replacement, you may benefit from physical therapy (PT) to help you fully recover. Your physical therapist will work with you to decrease pain, improve your shoulder range of motion, and improve upper extremity strength. This can ensure you regain maximal functional use of your shoulder and arm.

While your physical therapist may use various treatments as part of your total shoulder rehab, exercise should be one of the main components. So what are good PT exercises that may be done after total shoulder replacement?

Indications

Total shoulder replacement surgery is done to treat severe shoulder arthritis. This occurs when the cartilage of the ball and socket joint wears away. This leads to pain, limited motion, and difficulty performing basic functional tasks with your shoulder and arm.

During shoulder replacement surgery, your surgeon will cut out the end of your arm bone and the socket of your shoulder blade. Then, the bones will be replaced by metal parts. A small plastic cup fits between the metal allowing for smooth articulation between them. The surgery removes the arthritis and replaces it with new, metal pieces.

After total shoulder replacement, you will likely keep your arm in a sling for a few weeks. Once some healing has taken place, you may start physical therapy.

Types of Shoulder Replacement

There are two types of total shoulder replacement surgery that you may have: the total shoulder and the reverse total shoulder. The total shoulder replacement surgery involves cutting out the shoulder ball and socket, and the metal pieces inserted are placed in the exact anatomical position.

The reverse total shoulder replacement is a bit different. During this surgery, your doctor will cut away the ball and socket, and flip-flop them—the metal prosthesis with the ball will be attached to your shoulder blade and the socket will be attached to your upper arm.

The total shoulder replacement is usually done on patients with intact rotator cuff muscles.

The reverse total shoulder replacement surgery is chosen when the rotator cuff is damaged and not functional.

This means that rotator cuff strengthening exercises may be done only with the total shoulder. Rotator cuff strengthening exercises are avoided with a reverse total shoulder replacement.

Getting Started

When first starting exercises for your total shoulder replacement, be sure to check in with your doctor and physical therapist to ensure that exercise is safe for you to do. Your physical therapist can ensure that you are doing the correct exercises for your condition.

If any exercise causes lasting pain in your shoulder or arm, stop it and see your doctor.

Physical therapy exercises for total shoulder replacement progress from a gentle range of motion to more active strengthening. Finally, functional training exercises are performed.

1

Pendulums

The first exercise often recommended after a total shoulder replacement is a gentle pendulum exercise. This is done to start to allow your shoulder to hang freely from your body. This can help the muscles around the surgical site to relax a bit and can get some much-needed range of motion in your shoulder joint.

Doing shoulder pendulums is easy:

  1. Remove your shoulder from the sling if you are wearing one.
  2. Bend forward slightly at your waist, and place your non-operated hand on a flat surface like a table.
  3. Allow your operated shoulder to hang down towards the floor.
  4. Slowly and rhythmically rock your body so your shoulder moves in a small circle.
  5. Keep the circle small—only about 1 foot in diameter is all that is needed.
  6. Allow your shoulder to move in a circle for 10 repetitions in a clockwise direction, and then change directions and move your shoulder in a counterclockwise direction.

You can perform pendulums three times each day for about 10 repetitions. This is also a great exercise to get your arm away from your body enough so you can apply deodorant.

2

Self Range of Motion with a Cane

Once some healing has taken place with your total shoulder replacement, you may want to start gaining some range of motion. You can do this with a cane. To do cane range of motion:

  1. Obtain a cane or broomstick.
  2. Lie on your back on your bed or another firm surface.
  3. Hold the cane in both hands at your waist.
  4. Raise the cane up in the air overhead. Use your strong arm to guide your surgical arm up overhead.
  5. Slowly return to the starting position.
  6. Repeat 10 repetitions.

Don't be surprised if you cannot get your total shoulder arm fully up overhead. You may only be able to get your arm up a little bit. With regular exercise with the cane, you should be able to get overhead within a few weeks.

You can also use a cane to improve the way your shoulder moves out to the side of your body, a direction called abduction. To do this:

  1. Stand with your cane or stick in your hands at your waist.
  2. Use your non-operated arm to push your total shoulder replacement arm out to the side.
  3. Move your arm as far as possible out to the side, and then slowly return to the starting position.
  4. Repeat 10 times.

Shoulder range of motion can also be used with a pulley system attached to the top of your door.

3

Hand Grip Exercises

As you are healing from total shoulder replacement surgery, you may be required to keep your arm in a sling. During this time, the muscles of your forearm and hand may get weak. To combat this, your PT may prescribe hand grip exercises.

The simplest way to do hand grip exercises is with a towel. Simply roll up a hand towel, and squeeze it in your hand. Hold for a few seconds, and then relax. Repeat this for 10 to 15 repetitions.

Your physical therapist may also prescribe hand grip exercises with putty. You can obtain putty from your physical therapist, or simply purchase some at a craft store or dollar store. Gently squeeze the putty in your hand and hold for a few seconds. You can also pinch the putty with your fingers and thumb.

The hand grip exercises can be done while your arm is in the sling and may be started within a few days after surgery on your shoulder. Of course, always check with your doctor to be sure it's safe to start any post-op exercise.

4

Rotator Cuff Strengthening

The rotator cuff is a group of four muscles that support your shoulder and help with movement of your arm. Your physical therapist may prescribe rotator cuff strengthening exercises as part of your total shoulder replacement exercise program.

Do not perform rotator cuff strengthening exercises if you have had a reverse total shoulder replacement. Rotator cuff strengthening should only be performed if you have had a standard shoulder replacement.

To perform these exercises, obtain a resistance band from your physical therapist. Attach it to a secure item like a doorknob.

Use the band to provide resistance as you move your shoulder into internal rotation and external rotation. Keep your elbow tucked into your side, and slowly move your arm out away from your belly button. Then move your arm in towards your belly button while keeping your elbow tucked.

You can perform 10 to 15 repetitions of internal and external rotation exercises for your shoulder once a day.

5

Deltoid Strengthening

Deltoid strengthening exercises are important to perform if you have had a reverse total shoulder replacement. Why? As your deltoid muscle contracts to lift your arm, it seats the shoulder prosthesis into the ball of the joint, keeping it together and allowing it to move. Strengthening the deltoid is essential for proper function of your reverse total shoulder replacement.

You can also perform deltoid strengthening if you have had a standard total shoulder replacement. To strengthen your deltoid:

  1. Stand with your arm at your side.
  2. Lift your arm up in front of you, keeping your palm facing down.
  3. Raise your arm until it is parallel with the floor, and then hold for a few seconds.
  4. Slowly lower your arm down.
  5. Repeat 10 to 15 repetitions.

To strengthen the side of your deltoid:

  1. Stand with your arm at your side.
  2. Lift your arm out to the side.
  3. Raise your arm until it is parallel to the floor.
  4. Lower your arm slowly.
  5. Repeat 10 to 15 repetitions.

As you get stronger, you can do things to make the exercise more challenging. First, you can use your resistance band (that you got from PT) and hold that while you raise your arm in front or to the side. Or you can choose to hold a small two or three-pound dumbbell while you lift your arm. (A soup can is a good alternative to a dumbbell as well.)

6

Biceps and Triceps Strengtheing

Your biceps muscle travels down the front of your arm from your shoulder to your elbow. To strengthen this muscle, simply stand with your arm at your side. Bend your elbow up as if you were trying to touch your shoulder. Slowly lower down, and repeat 10 to 15 times. You can make this more challenging by holding a two to three-pound dumbbell or by using a resistance band.

Your triceps muscle travels down the back of your arm from your shoulder to your elbow. To strengthen this muscle, lie on your back with your arm straight up in the air. Allow your elbow to bend slowly. Then, strengthen your arm up against the force of gravity. Repeat 10 to 15 times.

You can hold a two to three-pound dumbbell while you do this to make it more challenging. (Be sure you have a good grip on the weight; you don't want to drop it on your head or face.)

7

Putting It All Together

Once you have worked on gaining full range of motion and strength in your shoulder and arm, your physical therapist can work with you to engage in functional activities. What things are difficult for you to do? What occupation or recreational activity do you wish to return to?

Your physical therapist can ensure that you practice the right movements and activities so you can regain as much function as possible after your total shoulder replacement surgery. These movements may include working on repetitive lifting, reaching, or gentle weight bearing onto your arm.

A Word From Verywell

A total shoulder replacement surgery can be a painful experience that limits your ability to properly move your arm. One of the goals of physical therapy is to help you regain normal motion and strength of your arm. By working hard in PT and by performing a specialized PT exercise program, you can be sure to quickly and safely get back to your maximal level of function after your total shoulder surgery.

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Article Sources

  • Denard PJ, Lädermann A. Immediate versus delayed passive range of motion following total shoulder arthroplasty. J Shoulder Elbow Surg. 2016;25(12):1918-1924. DOI: 10.1016/j.jse.2016.07.032