Reverse Total Shoulder Arthroplasty — (rTSA)

Sutter Health / Palo Alto Medical Foundation · Kevin Roth MD

Weight-Bearing

N/A (upper extremity)

Key Restrictions

Sling at all times except exercise/dressing/eating/showering wks 0-3; wean sling wks 3-6 (night + out of house only); D/C sling wk 6; maximum ER to neutral wks 0-3; avoid arm extension wks 0-12 (dislocation risk); no pulleys first 6 weeks; no passive manipulation of prosthesis; lifting limit 15 lbs lifetime

Timeline & Phases

Phase I (wks 0-6): wks 0-3: sling at all times except activity, max ER to neutral, keep elbow forward of midline when supine (reduces extension/dislocation risk), pendulums/Codman's, maintain hand/elbow/wrist motion, no pushing up from chair/bed; wks 3-6: wean sling (night + out of house), supine AAROM (FE 90°, ER neutral), towel-assisted flex/ABD/ADD/IR, begin ER at 6 wks (5-10 reps), pool PROM/AAROM, light scapular strengthening | Phase II (wks 6-12): D/C sling, continue PROM, increase AAROM supine → seated → standing, AROM straight planes against gravity at 6 wks (no combined motions yet), pool AAROM/AROM, closed-chain proprioceptive exercises (wall washing), arm bike no resistance | Phase III (wks 12-18): AROM with combined motions at 12 wks, light strengthening (lats/rhomboids/biceps/triceps/pecs/deltoids), pool with floats/paddles for light resistive work

Notes

Published 2024; gradual (not stepped) progression; dislocation risk concern wks 0-12 — avoid extension, keep elbow forward of midline when supine; no pulleys first 6 weeks; passive manipulation of prosthesis not recommended; active FE goal 130°; active ER goal 30-45° (if posterior RC intact); without posterior RC + no tendon transfer, patient will not achieve active ER strength and may be unable to reach face/head; IR typically less than anatomic TSA (may only reach lower lumbar); rTSA is salvage procedure with higher failure rates — lifetime lifting limit 15 lbs (vs 25 lbs for anatomic TSA); Kevin Roth MD Orthopedic Sports Medicine, Palo Alto CA (650-853-2943)

Surgeon / Author

Kevin Roth MD

Published

2024