1. Christina Beutler, Brandi Gau, Paige Heiberger, Julie Smith

2. Osteoarthritis Rheumatoid Arthritis Arthritis of dislocation Avascularnecrosis Acute fractures Post traumatic arthritis Cuff tear arthroplasty Tumor around the shoulder Pain Activities Sleeping Loss of ROM Loss of external rotation Decreased ability to perform overhead activities Decreased ability to perform ADLs

3. Severe mental dysfunction Weak rotator cuff Patients whose symptoms are not sufficiently disabling to warrant surgery Loss or paralysis of both rotator cuff and deltoid muscles Active infection A progressive disease of the nervous system that has affected the joint

4. Humeral head is removed Glenoid is reshaped Plastic components are attached Humerus is hollowed out Metal stem implanted in humerus Metal head attached to stem Rejoining of new components of humerus and glenoid https://www.youtube.com/watch?v=dQvcWSzOhms

5. Short exercise sessions 4 – 5 times per day Low number of repetitions PROM or AAROM exercises within pain free range Keep elbow at waist during ADLs Sling Positioning

6. Avoid sudden forceful movements of shoulder and reaching behind back Avoid weight bearing and lifting heavy objects Avoid AROM and RROM Avoid excessive stress to anterior capsule and suture line Avoid shoulder hyper extension or horizontal abduction beyond neutral No driving

7. Patient Education Pain Control PROM Codman’s Pendulum Exercises https://www.youtube.com/watch?v=gn4LDOkWRHk Arm in sling at rest Active exercises to elbow, wrist, and fingers Passive external rotation

8. Passive elevation in the plane of the scapula Pulleys 120 degrees of elevation Instruct in ADLs Leave hospital

9. Wear sling while outdoors Able to bring hand to mouth for eating May use hand for writing Active use as tolerated

10. Gentle elbow ROM Codman’s Pendulum Exercise Full passive forward elevation and ER and pulleys as tolerated Light isometrics Cold pack Ultrasound TENS for pain Advance to hot packs after sutures removed AVOID: Excessive resistance Extension Scapular substitution

11. Full ROM as tolerated Overhead training Supine elevation with a stick Pulleys

12. Begin gravity eliminated elevation, IR, and extension stretches Wall stretches

13. Discontinue sling Advance use in ADLs Isometric exercises for Rotator Cuff and Deltoids Advance resistive exercises and passive stretching AVOID: Excessive resistance in IR

14. Add isokinetic as patient progresses Modified sports are allowed

15. Progressive return to sports Progress stretching and strengthening

16. Shoulder stiffness Usually a result of incomplete rehabilitation Instability The ball slipping out of the socket Infection Nerve damage Glenoid loosening

17. Craig, Edward V., MD. "Shoulder Replacement Surgery: Diagnosis, Treatment, and Recovery." Hospital for Special Surgery. N.p., 1 July 2013. Web. 29 Oct. 2014. Donatelli, Robert. "Chapter 20." Physical Therapy of the Shoulder. Fourth ed. St. Louis, MO: Churchill Livingstone, 2004. 529-51. Print. Dreeben-Irimia, Olga. "Section 9-1." Physical Therapy Clinical Handbook for PTAs. Second ed. Burlington, MA: Jones & Bartlett Learning, 2013. 466. Print. Kisner, Carolyn, and Lynn Allen. Colby. "Chp 17." Therapeutic Exercise: Foundations and Techniques. Sixth ed. Philadelphia: F.A. Davis, 2007. 539-611. Print. Kisner, Carolyn, and Lynn Allen. Colby. "Shoulder." Ther Ex Notes Clinical Pocket Guide. Philadelphia, PA: F. A. Davis, 2011. 85-88. Print. "Pendulum Exercises." YouTube. YouTube, n.d. Web. 29 Oct. 2014. Procedure Videos. Glacial Lakes Orthopaedics: Orthopaedic Surgery & Sports Medicine. http://www.glaciallakesorthopaedics.com/cms/patients/procedure-videos/ Robertson, William J., MD. "Shoulder Arthroplasty." Southwestern Sports Medicine. Web. 29 Oct. 2014. "Total Shoulder Arthroplasty." YouTube. YouTube, 15 Aug. 2011. Web. 29 Oct. 2014.