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?
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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 degenerated parts of the joint on the "ball and the socket" of your shoulder joint. Then, the "ball" will be replaced by a metal part. A small plastic piece is used to replace the socket, allowing for smooth articulation between them.
After total shoulder replacement, you will likely keep your arm in a sling for a few weeks. Once some healing has taken place, your healthcare provider may prescribe physical therapy.
Types of Shoulder Replacement
There are two types of total shoulder replacement surgery that you may have: total shoulder replacement or reverse total shoulder replacement. Total shoulder replacement surgery involves cutting out the shoulder ball and socket and replacing them with metal and plastic parts.
The reverse total shoulder replacement is a bit different. During this surgery, your healthcare provider 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.
Hence, the exercises and rehabilitation after each type of surgery may differ. 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 healthcare provider and physical therapist to ensure that exercise is safe for you to do and that you are doing the correct exercises for your condition.
Physical therapy exercises for total shoulder replacement progress from a gentle range of motion to more active strengthening. Finally, functional training exercises are performed.
If any exercise causes lasting pain in your shoulder or arm, stop it and see your healthcare provider.
1
Pendulums
The first exercise often recommended after a total shoulder replacement isa 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 gentle range of motion in your shoulder joint.
Doing shoulder pendulums is easy, but make sure you have your surgeon's and PT's OK before performing these at home.
- Remove your shoulder from the sling if you are wearing one.
- Bend forward slightly at your waist, and place your non-operated hand on a flat surface like a table.
- Allow your operated shoulder to hang down towards the floor.
- Slowly and rhythmically rock your body so your shoulder moves in a small circle.
- Keep the circle small—only about 1 foot in diameter is all that is needed.
- 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.
2
Self Range of Motion With a Cane
Once your shoulder has healed enough, your healthcare provider may want you to start gaining some range of motion. Your PT can show you do this with a cane or broomstick. To do cane range of motion:
- Lie on your back on your bed or another firm surface.
- Hold the cane in both hands at your waist.
- Raise the cane up in the air overhead. Use your strong arm to guide your surgical arm up overhead.
- Slowly return to the starting position.
- 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. You should be able to get overhead within a few weeks. It is important not to force your shoulder in any direction.
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:
- Stand with your cane or stick in your hands at your waist.
- Use your non-operated arm to push your total shoulder replacement arm out to the side.
- Move your arm as far as possible out to the side, and then slowly return to the starting position.
- 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 healthcare provider 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 stabilize 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.
Modifications to avoid placing too much stress on the rotator cuff may be made if you have had a reverse total 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. For strengthening the external rotators, keep your elbow tucked into your side, and slowly move your forearm out away from your belly button. For internal rotation, 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:
- Stand with your arm at your side.
- Lift your arm up in front of you, keeping your palm facing down.
- Raise your arm until it is parallel with the floor, and then hold for a few seconds.
- Slowly lower your arm down.
- Repeat 10 to 15 repetitions.
To strengthen the side of your deltoid:
- Stand with your arm at your side.
- Lift your arm out to the side.
- Raise your arm until it is parallel to the floor.
- Lower your arm slowly.
- 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.)
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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 is a reliable treatment for severe shoulder arthritis, but initially after surgery you may feel limited in your ability to properly move your arm. One of the goals of physical therapy is to help you regain normal motion and strength. Performing a specialized PT exercise program that is prescribed by your surgeon will help you to safely get back to your maximal level of function.
Staying Motivated in PT
Insights, advice, suggestions, feedback and comments from experts
Based on the information provided in the article, here is a breakdown of the concepts discussed:
Total Shoulder Replacement Surgery
- Total shoulder replacement surgery is performed to treat severe shoulder arthritis, where the cartilage of the ball and socket joint wears away, causing pain, limited motion, and difficulty performing basic tasks with the shoulder and arm.
- During the surgery, the degenerated parts of the joint are cut out, and a metal part replaces the ball while a small plastic piece replaces the socket, allowing for smooth articulation between them.
- There are two types of total shoulder replacement surgery: total shoulder replacement and reverse total shoulder replacement.
- Total shoulder replacement surgery involves replacing the shoulder ball and socket with metal and plastic parts.
- Reverse total shoulder replacement surgery involves flipping the ball and socket, attaching the metal prosthesis with the ball to the shoulder blade and the socket to the upper arm.
- The choice between the two types of surgery depends on the condition of the rotator cuff muscles. Total shoulder replacement is done when the rotator cuff is intact, while reverse total shoulder replacement is chosen when the rotator cuff is damaged and not functional.
Physical Therapy (PT) after Total Shoulder Replacement
- Physical therapy is beneficial for individuals who have undergone total shoulder replacement surgery to aid in their recovery.
- The goals of physical therapy after total shoulder replacement include decreasing pain, improving shoulder range of motion, and enhancing upper extremity strength to regain maximal functional use of the shoulder and arm.
- Exercise is one of the main components of physical therapy after total shoulder replacement.
- Physical therapy exercises progress from gentle range of motion exercises to more active strengthening exercises, and finally, functional training exercises.
- It is important to consult with a healthcare provider and physical therapist before starting any exercises to ensure safety and appropriateness for the individual's condition.
- Some common physical therapy exercises after total shoulder replacement include pendulums, self-range of motion with a cane, hand grip exercises, rotator cuff strengthening exercises, deltoid strengthening exercises, and biceps and triceps strengthening exercises.
- The specific exercises prescribed may vary depending on the type of shoulder replacement surgery and the individual's condition.
Specific PT Exercises after Total Shoulder Replacement
- Pendulums: A gentle pendulum exercise is often recommended as the first exercise after total shoulder replacement. This exercise involves allowing the shoulder to hang freely from the body and moving it in a small circle.
- Self Range of Motion With a Cane: Once the shoulder has healed enough, range of motion exercises can be performed using a cane or broomstick. These exercises involve raising the arm overhead and moving it out to the side.
- Hand Grip Exercises: Hand grip exercises are prescribed to combat weakness in the forearm and hand muscles. These exercises can be done using a towel or putty.
- Rotator Cuff Strengthening: Rotator cuff strengthening exercises may be included in the exercise program, depending on the type of shoulder replacement surgery. These exercises involve using a resistance band to move the shoulder into internal and external rotation.
- Deltoid Strengthening: Deltoid strengthening exercises are important for individuals who have had a reverse total shoulder replacement. These exercises involve lifting the arm up in front and to the side.
- Biceps and Triceps Strengthening: Strengthening the biceps and triceps muscles can be done by bending the elbow up and down while standing or lying down.
Functional Activities and Return to Normal Function
- Once range of motion and strength have been improved, physical therapists can work with individuals to engage in functional activities that are specific to their needs and goals.
- Functional activities may include repetitive lifting, reaching, or gentle weight-bearing onto the arm.
- The goal is to regain as much function as possible after total shoulder replacement surgery.
It is important to note that the information provided is a summary of the concepts discussed in the article. For more detailed information and specific exercise instructions, it is recommended to consult with a healthcare provider or physical therapist.
