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What Does the Research Say?
The First 6 Weeks After Anatomic Shoulder Replacement: A Clinician's Guide
Phase 1 rehabilitation protects the subscapularis repair while preventing stiffness. These are the numbers that define safe early mobilization.
Elevation Limit
120°
Maximum passive elevation in scapular plane
External Rotation Limit
30°
Maximum passive ER with arm at side
Sling Duration
4-6 wk
Continuous wear, neutral rotation position
ASSET GuidelinesThe American Society of Shoulder and Elbow Therapists published a consensus statement in 2020 providing the foundational framework for anatomic arthroplasty rehabilitation. Only 23% of publicly available protocols follow these guidelines closely.
Active Elevation
✗
Strictly contraindicated during Phase 1
Pain Threshold for Progression
<3/10
Required before advancing to Phase 2
Neutral Sling Position
✓
May reduce night pain vs internal rotation sling (2023 APTA guideline)
Early vs Delayed Rehab
0
No significant difference in outcomes at 12 months (2022 systematic review)
3 Takeaways for Your Practice
1
Tissue Protection
These Limits Exist for One Reason: The Subscapularis
The 120 degree elevation and 30 degree external rotation limits protect the subscapularis repair. Exceeding them risks the most common complication of anatomic arthroplasty. Respect the numbers.
2
Assessment Milestone
Before Phase 2, Confirm Three Things
Pain consistently below 3/10 with passive ROM. Well-healed incision without signs of infection. Surgeon clearance after radiographic assessment at the 4 to 6 week visit.
3
Evidence Application
Early Motion Helps, But Strict Limits Matter More
Starting passive ROM on day 1 prevents stiffness without increasing complications. But the specific limits, not just "early motion," are what protect the repair. Follow the numbers exactly.
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This content is for informational purposes for licensed clinicians and does not constitute medical advice or a substitute for your own clinical research and judgment. Content may include AI-synthesized information; all clinical data, protocols, and dosages must be verified against official primary sources prior to patient care. Any reference to CE rules or regulations is provided as a guide and must be independently verified against current governing body requirements prior to completing credits. This article may contain links to external websites or third-party AI platforms. Ridley Learning has no control over the nature, content, and availability of those sites and does not necessarily endorse the views expressed within them. Ridley Learning is not liable for any injury, loss, clinical outcomes, or licensure issues resulting from the use of or reliance on this information. Your use of this site constitutes acceptance of these terms.
Meet the Author: Anne Osborn, PT, MPT
Anne Perry Osborn is a distinguished physical therapist and entrepreneur with over two decades of experience bridging clinical practice and healthcare education. She holds a Master of Physical Therapy from Texas Tech University Health Sciences Center and currently serves as the Owner and Director of Quality and Accreditation at Ridley Learning. With a background that includes clinical roles in outpatient rehabilitation and home health, Anne brings practical, hands-on insight to her leadership in continuing education, ensuring that learning opportunities remain relevant and impactful for today's practitioners.
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