Reverse Total Shoulder Arthroplasty Rehabilitation

Home » BlogJanuary 5, 2017

Principles:

A reverse total shoulder (rTSA) is performed for degenerative changes of the glenohumeral (shoulder) joint in patients with a nonfunctional rotator cuff or in patients with massive and irreparable rotator cuff repairs. To perform a reverse total shoulder arthroplasty the ball of the joint is placed on the glenoid – or on the previous cup portion of the joint – and the cup is placed on the humerus. This allows the deltoid to function independently to produce motion of the shoulder.

In general, initial rehabilitation after total shoulder replacement focuses on three areas:

  1. Maintain shoulder mobility
  2. Prevent dislocation – rTSAs dislocate in adduction, internal rotation and extension
  3. Maintaining elbow, wrist, and finger motion

As you rehabilitate your shoulder you will be passed from through phases of rehabilitation based upon both time and your progress with rehab.

Immediate Postop:

  • Ice for swelling and postoperative pain
  • You may shower on Postoperative day 5 without the wound covered
  • Take one 325mg aspirin once per day for 4 weeks to help prevent blood clots
  • Take stool softeners to prevent constipation

Week 1-6 (Restore ROM)

  • No extension or shoulder motion behind the back x 12 weeks
  • Passive Range of Motion 2 wks then AAROM.
    • Flexion to 90 degrees in the scapular plane – increase to 120 at week 4
    • External rotation of 0 degrees – increase to 60 degrees at week 4
    • Internal rotation to belly but NO internal rotation exercises behind the back
  • Passive Range of Motion only for 6 weeks
  • Sling for 6 weeks at night. After 2 weeks the sling can be removed for daily activities, but no reaching behind the back
  • Full elbow, wrist, and finger range of motion three times per day. No lifting great than 1 pound with biceps
  • Pendulums with 20 cm diameter circle maximum
  • Active scapular retraction and shrugs started immediately
  • Remove the sling at the conclusion of week 6

Week 7-12 (Start Strengthening)

  • Increase PROM to full flexion and ER
  • Initiate AROM in the scapular plan
  • Continue to avoid shoulder extension until postop week 12
  • Continue to avoid extension, adduction, and internal rotation

Week 13-18 (Strengthening & Activity training)

  • Okay to start lifting objects with operative extremity but not to exceed 8 pounds
  • No sudden lifting, pushing, or pulling
  • Begin strengthening of the shoulder with biceps, deltoid, periscapular muscles
  • Can begin to work on reaching behind the back at this point but under supervision

Week 19 and on (Increased Activity)

  • Work toward discharge goals of 120 degrees forward flexion with 30 -60 degrees external rotation
  • Continue to work on strengthening and work on developing a home exercise program

Additional Principles:

  1. The principles of surgery around most joint is similar:
    1. Protect any repairs
      1. For rTSA we protect the biceps tenodesis for 6 weeks. We also allow the soft tissue to solidify to prevent shoulder instability
    2. Obtain full range of motion
    3. Strengthen the muscles surrounding the joint
  2. You will have x-rays performed at your 2 week and 6 week and 12 week appointments.
  3. If sutures or staples need to be removed this will be done at the 2 week appointment.
  4. If you develop any increase in pain, fevers, chills, wound drainage, shortness of breath, or any other concerns please contact the office at 307-578-1955.