This operative procedure is performed in cases of severe Osteoarthritis or Rheumatoid arthritis where pain is the predominant feature. Early mobilisation is encouraged.

As subscapularis is released and reattached to the anatomical neck of humerus at the end of the procedure, there should be no resisted internal rotation for the first three weeks and care should be taken with the range of external rotation.
 
Post op: Day 1

• Polysling fitted in theatre
• Finger, wrist and elbow ROM exercises
• Shoulder girdle exercises and postural awareness, Neck ROM exercises

 Day 2  (Discharge)

• Axillary hygiene taught
• Pendular exercises
• Passive flexion/extension in scapular plane in supine

 Discharge to 3 Weeks

• Remove sling when comfortable
• Pendular exercises continued
• Isometric strengthening exercises of all muscle groups (except IR)
• Begin passive abduction (maintain shoulder in IR)
• Begin passive external rotation to neutral only.
• Begin active assisted flexion in supine and progress to sitting position as soon as the patient is able. Progress to active when possible.

 3 Weeks – 6 Weeks

• Encourage the patient to actively move into all ranges. Gentle assisted stretching exercise to increase range – do not force inner range ER
• Add isometric IR – sub maximally and only if pain free
• Commence isometric theraband exercises – resistance dependent on individual
• N.B. Take care with IR
• Encourage proprioceptive exercises-weight and non-weight bearing

 6 Weeks

• Progress strengthening and include anterior deltoid exercises
• Continue to regularly stretch the joint to end of its available range
• Can begin breaststroke if pain and range of movement allows

 How well the patient progresses, and the outcome will depend on the condition of the joint and soft tissues preoperatively. A better outcome is expected with patients whose joint is replaced for primary OA. Improvement continues for 18 months to 2 years and the patient should continue exercising until their maximum potential has been reached. The protocol outlined applies to patients with an intact rotator cuff. If a rotator cuff repair has been carried out in addition, the therapist should adhere to the strengthening protocol for the repair.

Return to Functional Activities

• These are approximate and may differ depending upon each patient’s individual achievements. However, they should be seen as the earliest that these activities may commence.
• Driving After 4 weeks
• Swimming: Breaststroke 6 weeks, Freestyle 3 months
• Golf 3 months
• Light lifting can begin at 3 weeks. Avoid lifting heavy items for 6 months.
• Return to work – Dependent upon the patient’s occupation: Those with sedentary jobs may return at 6 weeks; Manual workers or those whose occupations demand excessive shoulder use should be guided by the surgeon.