The Shoulder Surgeon | Specialist keyhole surgery for the treatment of shoulder and elbow problems

The Shoulder Surgeon | Specialist keyhole surgery for the treatment of shoulder and elbow problems
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Common Shoulder Injuries

Shoulder Problems


Shoulder Replacement Protocol

The protocols should be goal orientated focusing on what the patient can achieve with ease and good quality movement / technique. The times are a guideline to allow you assess the patient’s progress.

Please note that this is the protocol for the patients having different shoulder procedures.

I have to stress the fact that this protocol applies to most patients but not all. Please refer to operation notes for any special instructions. If there are no special instructions you may follow these protocols.

If for whatever reason you are concerned please do not hesitate to contact me. If you can’t contact me please contact a doctor, preferably from my team.

Thank you.


Post op Action

Day 1

  • Poly sling with body belt
  • Patients must have Cryocuff / ice packs
  • Assessment by OT
Day 2
  • Axillary hygiene
  • Finger, wrist and elbow exercises
  • Teach how to remove sling and replace it safely before discharge
  • Postural retraining
  • Closed chain active supported flexion within pain free ROM (eg hands on table and walk away, duster slides on table / gym ball)
  • Limit ER to neutral (?or in pain free ROM do not force ROM)
  • Closed chain abduction in scapula plane (ie bilateral dusting table in diagonal pattern)
  • Body belt could be removed when comfortable
1 – 3/52
  • Avoid forced passive external rotation or resisted internal rotation for 6/52
  • Passive external rotation limited to neutral (? See above re ER)
  • Wean off sling by 3/52
  • Active assisted flexion in supine and progress to sitting position as soon as the patient is able. (deltoid training program)
  • Isometric strengthening (except IR)
  • Functional reaching activities in pain free ROM, with good quality of movement and recruitment of cuff muscles
3 – 6/52
  • Isometric exercises through ROM
  • Avoid resisted IR until 6/52
  • Progress closed chain exercises against gravity (eg dusting wall)
  • Open chain bilateral active assisted elevation (eg short lever elevation with football in hands)
  • Continue with postural correction and movement re-education as required
  • HBB as comfortable mild stretch only
6/52 & beyond
  • Progress active ROM in all directions with good humeral scapula rhythm
  • Gradual introduction to resistance exercises within a pain free ROM if patient is able to perform ex with control