Reverse Total Shoulder Arthroplasty — (rTSA)

University Hospitals · Christopher LeVan, PT; John Campolieti, PT; Jeffrey Daniel Chelette, PT; Alison…

Weight-Bearing

Non-weight bearing through affected UE; abduction sling worn 4-6 wks per surgeon discretion (except during exercise)

Key Restrictions

Avoid shoulder adduction, extension and IR for 12 weeks (dislocation precaution) unless directed by surgeon; ER in coronal-plane abduction discouraged; possible ER ROM/active IR limitation 4-6wks depending on surgical approach; life-long weightlifting restriction likely - confirm with surgeon; Phase I (0-2wks): no AROM, NWB through UE, PROM limited to 90 deg flexion/30 deg ER scapular plane, no IR past neutral; Phase II (2-6wks): avoid active IR/adduction/extension, avoid cross-body horizontal adduction, no lifting >1-2 lbs; Phase III (6-12wks): no resisted IR x8-10wks, avoid hyperextension/IR behind back, no aggressive IR/ER ~45 deg, no lifting >5lbs

Timeline & Phases

Phase I (0-2wks): protect implant/healing tissue/subscapularis, pain/swelling control, gradual PROM; Phase II (2-6wks): protect from dislocation/acromial overload, progress PROM, submax isometrics, regain ADL independence; Phase III (6-12wks): scapulothoracic recruitment, isometrics to isotonics, wean sling, goal ~100 deg active flexion/~50 deg ER; Phase IV (12wks+): pain-free ADLs and return to lifting, low-to-moderate-impact recreational activity, IR strengthening, goal 110-150 deg flexion, physician clearance for moderate-impact activities

Notes

Indicated for massive/irreparable rotator cuff tears, proximal humerus fracture with deficient cuff, or revision TSA w/ cuff insufficiency; forward flexion AROM may plateau at 6 months, ER may continue improving up to 12 months, limited IR recovery expected vs. pre-op; outcome measures: QuickDASH, PSFS; high-impact/contact sports generally not recommended, no lifting >10lbs overhead in Phase IV; discharge (athletic): >90% strength vs. uninvolved UE, MD clearance; extensive references

Surgeon / Author

Christopher LeVan, PT; John Campolieti, PT; Jeffrey Daniel Chelette, PT; Alison Ives, PT (reviewed January 2025 by Mario Gastaldo, PT; physician review February 2025: Brian Victoroff, MD, Jacob Calcei, MD, Martin LeLand, MD, Robert Gillespie, MD, Raymond Chen, MD)

Published

2025-02