Reverse Total Shoulder Arthroplasty — (rTSA)

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

NWB on surgical side (no pushing up from chair) Phase I; strict sling use (off only for therapy) x4-6 wks

Key Restrictions

No shoulder active ROM Phase I; small pillow/towel behind elbow when supine to avoid hyperextension; formal PT no sooner than 4 wks post-op; PROM of IR not to exceed 50 deg in scapular plane Phase II

Timeline & Phases

Post-Op 0-4 wks: pain control and one-handed ADLs, gentle ROM, protect surgical reconstruction, strict sling use (off only for therapy) x4-6 wks, small pillow/towel behind elbow supine to avoid hyperextension, NWB on surgical side (no pushing up from chair), no shoulder active ROM, transfer/gait training with NWB on surgical side, hand/wrist/elbow ROM exercises, Codman's/pendulum exercises TID, scapular clocks, scapulothoracic mobilizations, after 4 wks initiate AAROM with T-bar/pulleys, deltoid submaximal isometrics in neutral, grade I-II shoulder joint mobilizations, walking with sling on; progress to Phase II after 6 wks with pain-free PROM; Phase II (4-12 wks): restore AROM, minimize pain, optimize shoulder strength, progress PROM, initiate PROM of IR to tolerance (not exceeding 50 deg) in scapular plane, AROM progressing to light deltoid/biceps/triceps strengthening, isometrics progressing to TheraBands, walking/Stairmaster/stationary bike; Phase III (12+ wks): progress functional strength and endurance, add PREs with no restrictions, begin functional progression for sports and activity-related tasks

Notes

OSMS Rehabilitation Guidelines; for fracture or rotator cuff damage indications; recommends pre-op planning to arrange help around the home for ADLs; references Brown & Friedman (Orthop Clin North Am 1998) and Wilcox/Arslanian/Millett (JOSPT 2005)