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Therapist Information and
Guidelines
Shoulder Hemiarthroplasty
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This operative procedure is
performed in cases of degeneration of the
humeral head due to Osteoarthritis, Rheumatoid
Arthritis or previous fracture in which
complications have developed (e.g. avascular
necrosis). The operation involves replacement of
the degenerative articular surface of the
humeral head with either a
resurfacing implant e.g. Copeland or a stemmed
implant.
This is an open procedure using either a
Deltopectoral or Anterosuperior approach.
The Deltopectoral approach is through a space
between the deltoid and pectoralis major muscle.
Postoperatively these muscles do not need
protected. The Anterosuperior approach
necessitates detachment and splitting of
Deltoid. Post operatively this does require
protection.
The subscapularis muscle is detached and
reattached to its insertion on the lesser
tuberosity in both approaches to the
glenohumeral joint. Post operatively it is
important to allow this repair to heal.
Therefore there should be-
NO External Rotation beyond
Neutral for 4 Weeks
NO Resisted Internal Rotation
for the first 6 Weeks
If a Rotator Cuff Repair has
been carried out in addition to this procedure
the therapist should adhere to the rehab
guidelines for the cuff repair.
Post Op
Day 1- Discharge
Patient wears a polysling or
abduction brace, normally for 3 weeks.
Finger, wrist, R/U joint and
elbow exercises.
Shoulder girdle exercises.
Teach postural awareness.
Commence passive shoulder ROM
exercises in supine as pain allows.
Flexion/Extension in scapular plane.
Abduction with arm in neutral or internal
rotation.
External rotation to neutral only.
Scapular stability exercises.
Day 4
Commence gentle pendular
exercises at the shoulder.
Commence active assisted
movements as pain allows. Begin in supine and
progress to sitting when able. (No ER beyond
neutral).
Progress to Active ROM exercises
as able.
Commence isometric strengthening
of all muscle groups,
Except Internal Rotation.
3 Weeks
Wean off sling when comfortable.
Encourage active movement in all
directions.
External rotation to neutral only.
Gentle assisted stretching to
increase range if required.
Progress to isotonic
strengthening, gradually increasing resistance
and range as able, except internal rotation.
Commence proprioceptive
exercises – weight and non weight bearing.
4 Weeks
Commence active external
rotation as comfortable beyond neutral.
6 Weeks
Joint stretches to end of
available range – can gently stretch into
external rotation but do not force.
Commence isometric strengthening
internal rotation.
Progress isotonic strengthening
exercises and include anterior deltoid
exercises.
Progress functional activities.
Return to
Functional Activities
These are approximate and may
differ depending upon the individual. They
should be seen as the earliest that these
activities should commence:
Driving: 4 Weeks
Swimming: Breaststroke 6 Weeks
Freestyle 3 Months
Golf: 3 Months
Lifting: Light lifting 3 Weeks
Heavy lifting 6 Months
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