Reverse Total Shoulder Arthroplasty — (rTSA)

Brigham and Women's Hospital · Reg B. Wilcox III PT; Dept. of Rehabilitation Services

Weight-Bearing

Sling/immobilizer 4-6 wks (4 wks isolated rTSA; 6 wks with tendon transfer or subscapularis repair); no shoulder AROM Phase I

Key Restrictions

Dislocation precautions x 10-12 wks: avoid shoulder extension beyond neutral AND combination of adduction + extension + IR; no lifting with operative UE; no supporting body weight with operative arm; keep elbow supported in supine ('always visualize elbow while on back'); if tendon transfer: PROM/AAROM start closer to wk 6, not earlier; subscapularis repair: delay accordingly; no soaking incision 2 wks; no swimming/jacuzzi/wading

Timeline & Phases

4 phases: Phase I (day 1-6 wks, post-surgical joint protection, PROM), Phase II (7-12 wks, active ROM and early strength), Phase III (wk 12+, progressive functional phase; shift to Levy deltoid program if AROM elevation <90 deg by 12 wks), Phase IV (typically 4+ months, home program, mostly functional strengthening); tendon transfer variants noted: Latissimus Dorsi (primary rTSA) vs Lower Trapezius (non-primary rTSA); updated 2022

Notes

2022; covers tendon transfer variants (LDT for primary, LTT for non-primary); discusses medializing vs lateralizing center of rotation concepts; deltoid as primary stabilizer emphasized; note: typically requires only functional strengthening — consult surgeon if additional strengthening indicated; extensive references including Boudreau et al 2007 JOSPT landmark rTSA rehab paper. [Archived copy — original Brigham and Women's Hospital URL retired in the Mass General Brigham site migration; Wayback snapshot 2026-02-28.]

Surgeon / Author

Reg B. Wilcox III PT; Dept. of Rehabilitation Services

Published

2022