Shoulder replacement surgery is often performed to combat the pain caused by arthritis if the shoulder is severely fractured or broken, or most commonly due to severe osteoarthritis. Osteoarthritis is a degenerative condition generally caused by the wearing down of cartilage, which is the shiny material covering the ends of the bones, allowing for smooth movement. With this wear and tear, the cartilage gets thinner and thinner, progressing to the point where the bone is rubbing directly on the bone.
When advanced osteoarthritis in the shoulder results in pain and loss of function, and all conservative treatments fail, joint replacement surgery becomes an option. Following shoulder replacement surgery, rest is highly recommended. However, light exercises are often prescribed to help avoid long-term complications.
Shoulder joints require different types of rehabilitative exercises following shoulder replacement surgery, depending on the type of surgery that was performed and the affected area of your shoulder. For example, range of motion exercises will help determine how far or how wide can your shoulders move and help keep you limber to avoid straining your shoulders. Strengthening exercises help you regain power and sturdiness in the shoulders to ensure you can lift items and carry out other daily tasks. Lastly, endurance exercises help improve your overall health and allow you to carry out movements and tasks without feeling exhausted. Endurance exercises also help determine how fast your shoulders adapt and recover.
After leaving the hospital post-surgery, follow the recommended guidelines:
- Rest when you feel tired. You can nap, but don’t stay in bed all day.
- Wear a sling at night and place a pillow or folded towel under your upper arm while you are in bed to help keep your arm in a safe position.
- Your arm should stay next to your body or in front of your body for several weeks, both while you are awake and during sleep.
- Don’t lift anything with the affected arm for 6 weeks.
- Use ice to help with pain management. Apply ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
- Work with a Physiotherapist to learn safe and effective exercises designed to help you regain mobility and strength in your shoulder. Follow their guidelines and recommendations.
When first starting an exercise program post-shoulder replacement, definitely consult with your doctor or physical therapist to ensure that you are ready for activity and that you are doing the correct exercises for your condition.
Exercises Commonly recommended Post Shoulder Replacement
1. Pendulums
The first exercise often recommended after a total shoulder replacement is a gentle pendulum exercise. This exercise helps the muscles around the surgical site relax and encourages some gentle range of motion in your shoulder joint.
Start in an upright standing position with your feet hip-width apart. Hinge from your hips to bend your upper body forward and place your non-surgical hand on a flat, sturdy surface for support. Allow your affected shoulder to hang down towards the floor, then slowly and rhythmically rock your body so that your arm moves in a small circular motion. Do not make the movement too large.
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Perform 10 repetitions in each direction, 3 times daily.
2. 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 in your forearm and hand can become weakened. This gentle exercise helps to maintain strength in your forearm and hand.
Simply roll up a hand towel and squeeze it in your hand. Hold for a few seconds, and then relax. Repeat the movement.
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Perform 10 – 15 repetitions, 3 times daily.
3. Rotator Cuff Strengthening
A rotator cuff is a group of four muscles that stabilize your shoulder and help with the movement of your arm. Your physical therapist may prescribe rotator cuff strengthening exercises as part of your total shoulder replacement exercise program. You will require some resistance tubing for these exercises.
Attach one end of your resistance tubing to something secure, like in a door frame.
Internal Rotations:
Hold the resistance tubing in the hand closest to the attachment point. Keep your upper arm aligned with your body and bend your elbow to hold the tubing in front of your body. Pull your lower arm inward across your body, keeping your elbow tucked against your side. Return to the starting position and repeat the movement.
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Perform 1 set of 10 – 15 repetitions, once daily
External Rotations:
Hold the resistance tubing in the hand furthest away from the attachment point. Keep your upper arm aligned with your body, bend your elbow and position your arm across your body.
Keep your elbow tucked into your side, and slowly pull your lower arm out to the side. Return to the starting position and repeat the movement.
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Perform 1 set of 10 – 15 repetitions, once daily.
4. 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 the proper functioning of your reverse total shoulder replacement. You can also perform deltoid strengthening if you have had a standard total shoulder replacement. Start off with just bodyweight, then slowly incorporate a light dumbbell once you have regained some strength and endurance.
Front Deltoid Strengthening
Start by standing in an upright standing position with your arms at your sides. Lift your arm up in front of your body, keeping your arm straight and your palm facing downward. Raise your arm until it is parallel to the floor and hold this position for a few seconds. Slowly lower your arm to the starting position and repeat the movement.
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Perform 1 Set of 10 – 15 repetitions, once daily.
5. Bicep and Tricep Strengthening
Bicep Strengthening
Your bicep muscles travel down the fronts of your arms, from your shoulders to your elbows.
Start in an upright standing position with your arms at your sides. Bend your elbow to raise your hand towards your shoulder. Slowly lower your arm to the starting position and repeat the movement. You can make this exercise more challenging by holding a light dumbbell or by using a resistance band.
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Perform 1 Set of 10 – 15 repetitions, once daily.
Tricep Strengthening
Your tricep muscles travel down the backs of your arms, from your shoulders to your elbows. Lie on your back with your arm extended upward at shoulder height. Slowly bend your elbow to bring your upper arm to the floor. Extend your arm to return to the starting position. You can make this exercise more challenging by holding a light dumbbell
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Perform 1 Set of 10 – 15 repetitions, once daily.
6. Finger Ladder Exercise
Finger ladder exercises help to improve the mobility of the shoulder, elbow, and wrist joints.
Start in an upright standing position, facing a wall. Place your fingers low on the wall. Use your fingers to walk your arm up the wall, stopping when you feel a stretch in your shoulder. Hold this position for 10 – 20 seconds, then slowly return to the starting position, repeating the movement in the opposite direction.
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Perform 1 Set of 5 – 10 repetitions, 3 times daily
7. Shoulder Forward Elevation
Start in an upright standing position with your arms at your sides. Slowly raise your arm upward, leading with your thumb and stopping with your arm overhead. Hold this position for 10 seconds, then slowly lower your arm to the starting position. Repeat the movement.
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Perform 1 set of 5 – 10 repetitions, 3 times daily.
8. Shoulder Abduction
Abduction occurs when your arm moves away from the middle of your body. When you raise your arm out from the side of your body, it’s the abduction of your shoulder. Do note that this exercise may not be recommended after certain surgeries. Check with your surgeon or physical therapist to ensure that it is appropriate for you.
Start in an upright standing position with your arms at your sides. Slowly raise your arm at your side, up to shoulder height, keeping your palm facing downward. Keep your body in alignment and do not shrug your shoulder. Hold this position for 10 seconds. Lower your arm down to the starting position and repeat the movement. To make this exercise more challenging, hold a lightweight or dumbbell.
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Perform 1 set of 3 repetitions, 3 times daily.
9. Shoulder Internal Rotation
Lie on your side with your affected arm along the floor. Bend your elbow to a 90-degree angle and hold a lightweight. Slowly raise your forearm across your body. Lower your arm to the starting position and repeat the movement.
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Perform 1 set of 10 repetitions, 3 times daily.
10. Shoulder External Rotation (Strengthening)
Lie on your unaffected side. Bend your elbow to a 90-degree angle and hold a lightweight in your hand. Slowly raise your hand upward, keeping your elbow tucked against your body. Slowly lower your arm to the starting position and repeat the movement.
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Perform 1 set of 10 repetitions, 3 times daily.
It is common to feel frustrated weeks after surgery, to the extent of feeling a bit stir-crazy at times. But remember that it will get better. Healing takes time, so be patient with yourself. At times you will exhaust easily, but these feelings are a normal part of your body’s healing process after surgery. Over time, as you are able to move more with less pain, you may find yourself feeling more tired instead of less. Do not feel guilty about an afternoon nap.
Discuss regular exercise with your surgeon or physical therapist before doing anything other than your prescribed physical therapy. Doing too much activity too soon can cause damage to your new joint and significantly delay your healing process.
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