Shoulder Joint Replacement: Returning to the highest level of function with Physical Therapy

By Dr. John R. Mishock, PT, DPT, DC

Shoulder replacement surgeries have dramatically increased in number over the past few decades. There are nearly 53,000 shoulder replacement surgeries performed in the United States annually. Over the years there have been dramatic advances in surgical procedure and rehabilitation, allowing a success rate as high as 92% in improved quality of life.

Total shoulder joint replacements are performed on individuals with; chronic shoulder pain from degenerative arthritis, unrepairable rotator cuff tears, and shoulder fractures. Before shoulder replacement surgery, individuals undergo a variety of conservative treatments to help reduce shoulder pain and improve function such as; anti-inflammatory medications, physical therapy, and injections (steroids, plasma rich protein, stem cell). If the patient does not respond to the conservative treatments, an orthopedist can perform the joint replacement surgery.
The recovery following shoulder replacement typically takes around 6 months. Initially, patients wear a protective shoulder sling and begin physical therapy as early as one week post-operatively.

Physical therapy starts with a thorough evaluation of the patient’s shoulder, along with their short-term and long-term functional goals. In the first phase of therapy, the patient is working on basic shoulder range-of-motion and gentle strengthening exercises. The physical therapist will use hands-on techniques (manual therapy) to improve shoulder joint range of motion and promote healing of the soft tissues and muscles. Modalities (electrical stimulation, vasopneumatic, ultrasound, ice, and heat), are used to help reduce pain and improve soft tissue healing.

In the second phase of rehabilitation, the goal is to gain the full range of motion of the shoulder while progressing the strength and endurance of the shoulder, scapular stabilizers (shoulder blade muscles), and core muscles (mid-section). The final phase of rehabilitation involves progressing the patient to the highest level of function in work or recreation.

Several studies have reported between 75–90% of patients return to their activity and exercise of choice. Many patients return to high-level activities such as; swimming, fishing, golf, and tennis. At physical therapy discharge, we expect 90% subjective and objective recovery. During the discharge planning, we create a written home exercise program that will be utilized following the rehabilitation process to reach the patient’s long-term goals.

Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania.
He has also authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought at or on Amazon.

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