*Important rehab guidelines to consider*
- Avoid shoulder Ext past neutral for 12 weeks
- Avoid internal rotation, adduction and extension as patients have a high likely hood of
dislocation with combined movements. Such as tucking in their shirt, and performing
bathroom/ personal hygiene - Stability and mobility of the shoulder is now dependent on the Deltoid and periscapular
function in patients with a rTSA - Restoration of Full Normal ROM is NOT expected
- Traditionally rTSA procedure is done via Superior approach, and in these cases;
- Early deltoid activity is CONTRAINDICATED
- Use of sling for 4-6 weeks
- No isometrics until 4 weeks
- No AROM Flex for 6 weeks
- No IR until 6 weeks
- No deltoid strengthening for 12 weeks
*Permanent Restrictions*
- No lifting, pushing, pulling more than 25 pounds
- No impact activities
Phase 1
1 to 4 weeks
- Sling for 4-6 weeks
- No shoulder Extension past neutral
- No AROM
- No lifting
- No supporting body weight
- A/AAROM Elbow, wrist, hand
- Periscapular sub max isometrics
- PROM only
- Flex in scapular plane 90 deg
- ER in scapular plane 20-30 deg
- NO IR
Phase 2
4 weeks
- Begin Sub max pain free isometrics ( avoid shoulder ext )
- PROM in a scapular plane
- Flexion to 120 deg
- ER to 45 deg
- Abd to 70
- NO IR
6 weeks
- PROM
- ER to 60 deg
- Begin IR to tolerance NOT to exceed 50 deg
- Initiate GH and ST joint mobs ( grade 1 and 2 )
- Begin Shoulder AAROM as tolerable with progression to sitting/standing
Phase 3
9 weeks
- Begin periscapular and deltoid sub max pain free deltoid isotonic/ PRE exercises
- Begin AROM supine forward flexion with light weights
- Progress GH joint IR ER isotonic ther ex progressing sidelying to standing
12 weeks +
- Continue to progress isotonic and PRE’s
- Progress AROM, proper mechanics, pain free ROM typically 80-120 deg of elevation and 30 deg of ER
- Progress act to tolerate light household and work activities
Click here to download: Reverse Total Shoulder Replacement
