Penrose Physical Therapy
01
Jan 2016
Jennifer Penrose
Author
Jennifer Penrose

*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

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