*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