Reverse Total Shoulder Arthroplasty — (rTSA)

UW Health Sports Medicine · UW Health Sports Medicine (Dr. Grogan, Dr. Anderson)

Weight-Bearing

N/A (upper extremity); permanent implant precautions: no contact sports, no heavy lifting, no chopping wood, no repetitive overhead throwing, no heavy labor

Key Restrictions

Dr. Grogan: sling for comfort/safety only (crowds, ice, uneven ground) — highly permissive; Dr. Anderson: sling at all times except shower/dressing/therapy for 2 weeks, sling while sleeping and in public weeks 2-6, discontinue by end of week 6; no treadmill or stair master until Phase IV; no running/jumping until Phase IV; no active IR restrictions at any phase (no subscapularis repair in rTSA)

Timeline & Phases

Phase I (0-4 weeks): sling, elbow/wrist/neck AROM, AAROM/AROM shoulder flex/ABD to tolerance, pendulums, pain-free submax isometrics (flex/ABD/ext/ER), walking/bike with sling; Phase II (4-8 weeks): PROM/AAROM all planes, progressive low-resistance isotonics, Jackins exercises for deltoid strengthening, rhythmic stabilizations, scapular strengthening, postural/core, sling D/C by end of week 6; Phase III (8-12 weeks): shoulder IR, Jackins exercises progression, open/closed kinetic chain stabilizations, PNF patterns, scapular strengthening, trunk/hip mobility; Phase IV (12-18 weeks): multi-plane AROM with increasing velocity, RTC at 90° ABD and overhead, scapular dynamic neuromuscular control, stair master/light jog with 5/5 strength; ER goal 75°; Phase V (18+ weeks): work/sport specific, return to sport with surgeon/AT/PT clearance

Notes

UW Health Sports Medicine; one PDF shared with TSA protocol; rTSA reverses ball-and-socket geometry (glenosphere on scapula, cup on humerus) to harness deltoid for elevation when rotator cuff is severely compromised; no IR restriction at any phase (subscapularis not repaired in rTSA); Jackins exercises are the key differentiator for deltoid strengthening in rTSA; ER goal of 75° at Phase IV (not unlimited unlike TSA); Dr. Grogan most permissive sling protocol; permanent implant precautions apply indefinitely

Surgeon / Author

UW Health Sports Medicine (Dr. Grogan, Dr. Anderson)