Reverse Total Shoulder Arthroplasty — (rTSA)

UCLA Department of Orthopaedic Surgery - Sports Medicine · Thomas Kremen MD

Weight-Bearing

N/A (upper extremity)

Key Restrictions

Sling immobilization; Stage I PROM/AAROM limited to <120° elevation (typically 90° tolerated), 0° ER, 45° abduction; no AROM/resistance Stage I; Stage II: no strengthening or forceful stretching, no PA with overpressure; Stage III: begin resistance only after ~140° FE + ~30° ER + radiographic healing (~12 wks); no lifting >5-10 lbs; no weight lifting above shoulder height; life-long restriction: max 25 lbs surgical arm / 50 lbs bilateral

Timeline & Phases

Stage I (wks 3-6): sling, PROM/AAROM: FE <120°, assisted ER to neutral, no extension, isometrics ER/posterior deltoid/middle deltoid | Stage II (wks 6-12): AROM supine FE with flexed elbow progressing toward 140°, gradual supine → vertical once 140° is smooth/controlled, active ER (expect only 20-40°), continue deltoid isometrics, no strengthening or resistance, no forceful stretching | Stage III (wk 12+): pool exercises, low-resistance theraband/light weights for deltoid, teres minor and subscapularis strengthening, submaximal isometrics → limited → full-range isotonics (below shoulder height preferred); Month 4: increase resistive exercises; rehabilitation continues 1 year

Notes

PT prescription form; Stage I begins at wks 3-6 (early post-op managed separately); expected FE ~90° at 3 months, >90° by 4 months; FE >140° may not be achievable; expected ER only 20-40° long-term; deltoid-dominant mechanics — scapular substitution with AROM elevation is expected and acceptable; begin resistance training only after ~140° FE + ~30° ER + radiographic healing on follow-up x-ray (~12 wks); do not stretch mild <20° abduction contracture; avoid forceful AROM/stretching in ROM >140° flex, >45° ER, IR behind frontal plane, horizontal adduction past neutral; life-long restriction: max 25 lbs surgical arm, 50 lbs bilateral; rehabilitation for 1 year; Kremen MD UCLA PatientPop practice site

Surgeon / Author

Thomas Kremen MD