March 18, 2021

You may need PT for shoulder replacement surgery before and after the procedure — here’s why.

We use our shoulders so much in our daily lives. That’s why osteoarthritis of the shoulder can be such a frustrating and painful condition. If you’re considering a shoulder replacement, you may be wondering about the commitment regarding physical therapy.

Physical therapy is most often prescribed after shoulder replacement surgery to help the muscles recover from the procedure. But physical therapy is sometimes prescribed before shoulder replacement surgery, as well. We reached out to John Kuhn, M.D., chief of shoulder surgery at Vanderbilt Orthpaedics, for his expertise on prehab (before surgery) and rehab (after surgery).

Prehab before shoulder replacement

If your pain improves with physical therapy prior to surgery, then joint replacement may not be necessary. “I typically will have patients try physical therapy for six weeks and see how they do,” Kuhn said. If pain persists, then surgery is often the best course of action.

Prehab also has the potential to help with the procedure and improve outcomes. “People with osteoarthritis in their shoulders frequently have pain and stiffness because the shoulder hurts when they move it,” Kuhn explained. “So they move it less. And that creates stiffness. And if the shoulder is stiff, we have to do a lot of releases of that scar tissue and stiffness to do the operation.” Physical therapy before surgery can help relieve the stiffness, and may help with pain.

Rehab after shoulder replacement

Physical therapy after shoulder replacement is designed to protect and heal shoulder muscles and tendons. “To do the operation,” Kuhn explained, “there’s a muscle in the front of the shoulder called the subscapularis that we detach so we can put the joint in, and then we repair that muscle.”

During physical therapy, you will safely and gradually regain range of motion. Then once the subscapularis is healed, strengthening can begin through continued therapy. “Many patients have not used their shoulder much for the years prior to their shoulder replacement,” Kuhn said. “And so they’ve developed a lot of atrophy and weakness. Getting that strength back will be important to having a shoulder that works as well as it possibly can.”

Time commitment

Kuhn said most patients require at least 12 weeks of physical therapy. However, if you have severe stiffness or weakness prior to surgery, then physical therapy after surgery may take up to 16 weeks. But Kuhn said it’s unusual for physical therapy to last longer than three to four months.

In many cases, you won’t need to commute to a clinic. “The world is changing,” Kuhn said. “So with teletherapy and other things, patients are doing a lot more of this at home, which I think is good.” Most patients will work with a physical therapist two to three times per week via telehealth if they’d like. But Kuhn said to plan for spending about 30 to 45 minutes each day on a variety of exercises.

After physical therapy

After that three-month period when you’ve completed your physical therapy program and have regained your range of motion, the journey continues. Kuhn said he recommends that patients maintain their strengthening regimen for additional improvement. “Patients are usually very happy at three months,” he said. “Their pain is gone, they’re sleeping better, their range of motion is good, and they’re doing activities around the house. But patients will still see gains in strength and endurance up to a year after the operation.”

If you have shoulder pain or a shoulder injury, the specialists in the Vanderbilt Shoulder Care Program can help you find relief. They provide a range of treatments, from physical therapy to total shoulder replacement.

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Jed Kuhn, M.D., is the Kenneth D. Schermerhorn Professor of Orthopaedics and director of Sports Medicine and Shoulder Surgery at Vanderbilt University Medical Center.