Physical Therapy After Total Shoulder Replacement Surgery

Updated on April 23, 2022

Medically reviewed by Oluseun Olufade, MD

If you have significant pain and loss of shoulder mobility due to shoulder osteoarthritis, you may benefit from a surgical procedure called a total shoulder replacement. The goal of the surgery is to remove the arthritic shoulder joint and replace it with a more functional metal, ceramic, or plastic joint. This joint then allows your shoulder and arm to move and function more normally.

A man in physical therapy — Westend61 / Getty Images

If you have had a total shoulder replacement, you may benefit from working with a physical therapist. Physical therapy (PT) for total shoulder replacement involves improving your shoulder range of motion, strength, and overall function while reducing pain. Knowing what to expect from PT after your total shoulder surgery can help you make the best decisions regarding your rehab.

Total Shoulder Replacement Surgery

During total shoulder replacement, an incision is made in your upper arm. Your shoulder joint is then exposed, and the surgeon will use specialized tools to cut away the arthritic joint. The ball on the end of your upper arm bone, the humerus, will be removed, and the glenoid socket of your shoulder blade will be removed.

Once the arthritic shoulder joint has been removed, a new joint will be placed. This joint is usually made of metal titanium and is composed of a metal ball and a metal socket with a small plastic piece between the two.

There are two types of shoulder replacements: the standard total shoulder replacement and the reverse total shoulder replacement. The standard total shoulder is done if your rotator cuff muscles of your shoulder are intact. If the rotator cuff is torn away and not salvageable, then the reverse total shoulder replacement will be done. This means that the metal socket will be secured to the end of your humerus and the metal ball is placed on your shoulder blade.

Most surgeons use a surgical approach that detaches the subscapularis tendon in the front of the shoulder, and repairs the tendon at the completion of the surgery. As a result, it is not uncommon for patients to have specific precautions on amount of passive external rotation allowed, and avoidance of active internal rotation for the first six weeks. Some surgeons perform replacement without detaching the subscap, so not everyone has this precaution, but many do. Each type of shoulder replacement involves specific rehabilitation techniques.

Once the new metal shoulder joint is placed, your shoulder will be sutured back together, your shoulder will be immobilized in a sling, and your recovery can begin.

After surgery, there will be a period of rest and recovery. You will follow up with your healthcare provider at regular intervals, and they will refer you to a physical therapist for rehab. This typically occurs about two to four weeks after surgery.

PT Evaluation

Your first appointment to a physical therapist after total shoulder replacement is called an initial evaluation. During this appointment, your physical therapist will ask you questions about your lifestyle, your shoulder, and your medical history. Various tests and measures will be done. These may include:

Pain measures
Range of motion
Strength measurements
Assessment of your surgical scar tissue
Palpation, or touching
Functional measurement

Once your physical therapist has gathered a baseline of your current functional status and impairments, he or she will discuss with you the course of rehab. This will include a plan of care and the setting of goals.

Typical goals after total shoulder replacement may include:

Return to full functional range of motion
Return to full strength in your shoulder and arm
Abolish pain
Be able to use your arm normally during work and recreational activities

Your rehab goals after total shoulder replacement may vary slightly—be sure you work with your physical therapist to set realistic and specific goals. Once your goals are set and you have a plan of attack in place, you can begin your total shoulder physical therapy treatment.

PT Treatment for Total Shoulder Replacement

Various treatments will likely be used during your rehab for total shoulder replacement. These may include both physical modalities and movements, like exercise.

Modalities

Your PT may use various things to improve circulation and control pain after total shoulder replacement including:

Ice: This is used to decrease pain and control swelling and inflammation.
Heat: Heat is used to relax muscles and decrease pain. Heat can also improve blood flow to your shoulder's tissues.
Electrical Stimulation: Electrical stimulation, like TENS, may be used to decrease pain. A form of e-stim called neuromuscular electrical stimulation (NMES) may be used to help your muscles contract properly after surgery.
Kinesiology Tape: K-tape may be used to help decrease pain and swelling or improve the muscular function of your shoulder.

Keep in mind that many physical therapists shy away from using physical modalities. Some feel that doing things to the patient creates a relationship where the patient is dependent on the therapist for care. Plus, many scientific reports show that modalities for total shoulder replacement do not improve functional outcomes.

Hands-On Care

Your PT may perform a few manual techniques to improve your shoulder mobility after total shoulder replacement. This may include:

Manual joint range of motion techniques
Manual resistance exercise
Scar tissue massage

These treatments are done to improve tissue mobility and overall functional motion and strength in your shoulder and arm.

Exercise

Exercise after total shoulder replacement should be the main focus of your rehab. An exercise program after total shoulder replacement may include:

Pendulums
Range of motion wand exercises
Isometric shoulder exercises
Shoulder active range of motion exercises
Strengthening exercises with a resistance band or weight
Function-specific exercises

Keep in mind that some exercises may hurt a bit while doing them. If this happens, tell your physical therapist; he or she may alter the exercise to make it more comfortable.

Your physical therapist will likely also prescribe exercises to be done daily as part of a home exercise program. These may be done several times a day to help relieve pain and improve shoulder and arm mobility.

Caution for Reverse Total Shoulder Replacement

It should be noted that if you have had a standard total shoulder replacement, rotator cuff exercises may be part of your physical therapy program. However, these should not be done if you have had a reverse total shoulder replacement. No rotator cuff muscle is present, so strengthening should focus on the deltoid muscle to help your arm move. Motions that rotate your shoulder externally to end range should be avoided.

How Long Will Therapy Last?

Most people who have an uncomplicated total shoulder replacement can expect to spend about six to eight weeks in physical therapy. Some people sail through rehab and reach their goals more quickly, while others take a bit more time. Most often, people are back to normal about 12 to 16 weeks after surgery. Be sure to work closely with your physical therapist and healthcare provider to understand your specific course of rehab.

A Word From Verywell

If you have had a total shoulder replacement surgery, you may benefit from working with a physical therapist during your recovery. Your shoulder replacement rehab will focus on helping you regain movement and strength in order to regain full pain-free function of your arm. Working with a physical therapist can help you quickly and safely get back to your normal work and recreational activities.

What to Expect From Physical Therapy

10 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.

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