Dr. Anthony A. Schepsis

Coastal Orthopedics
Beverly, MA
Professor of Orthopedic Surgery
Boston University School of Medicine

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schepsis@comcast.net

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Reverse Total Shoulder Arthroplasty Rehabilitation Program

                                                               Anthony A. Schepsis M.D.

                                                                                         Coastal Orthopedics

                                                                                          978-927-3040978-927-3040

REVERSE SHOULDER REPLACEMENT POST-OPERATIVE REHABILITATION PROGRAM

 

The goal of the rehabilitation process is to provide greater mobility to the patient then before the surgery. In addition, stability of the shoulder is vital and essential to normal non-painful shoulder function. The key to the success of the rehabilitation following total shoulder replacement is compliance to your exercise program.

PHASE ONE - IMMEDIATE MOTION PHASE (Week 0-4)

                    Goals:     Allow early healing of capsule

                     Increase passive range of motion

                     Decrease shoulder pain

                     Retard muscular atrophy

                     Assist with home exercise program

                     Restore active range of motion of elbow, wrist and digits

     Precautions:  Sling for _______ weeks

                            Avoid coupled adduction/internal rotation (tucking in shirt, hygiene)

                                    -Dislocation restriction for three months

                            No AROM of shoulder

                            No lifting or supporting weight

                            Limit ER to ______

WEEKS 1- 2

Please avoid coupled adduction/internal rotation.  Please avoid abduction with internal or external rotation

Exercises: 

  • ROM exercise:
  • Pendulum Exercises.  Ideally 4-5 times per day for 10-15 minutes
  • PROM
    • forward elevation in scapular plane to 90 degrees
    • ER to _______ (determined in OR)
  • Elbow/Wrist ROM
  • Gripping Exercise for Hand
  • Cryotherapy and modalities    
  • Isometrics (Day 10)
  • Abductors
  • Deltoid (not in extension!)
  •  Elbow flexors
  • Electrical Muscle Stimulation (if needed)

WEEKS 3-6

Sling ______ weeks

Exercises:

  • Continue all ROM exercises
  • Progress flexion to 120 degrees
  • ER in scapular plane to _____
  • Isometrics
  • Continue Deltoid in scapular plane

Criteria for phase II

  • Tolerates PROM of shoulder and isometrics
  • Able to isometrically activate deltoid and periscap muscles

PHASE TWO - ACTIVE MOTION PHASE (Week 6-12)

  • Goals:   
    • Improve dynamic stabilization and strength
    • Improve Range of Motion (passive and active)
    • Decrease pain/inflammation
    • Increase Functional Activities
    • Improve dynamic shoulder and scapula stability

  • Precautions:
    • Avoid shoulder hyperextension
    • Lifting restricted to 1 pound (coffee cup or bottle of soda)
    • No supporting body weight
    • Slow progression of deltoid given risk for acromial fracture

WEEKS 6-8

  • PROM program
  • D/C Sling
    • A/AROM
    • Forward elevation in scapula plane
    • ER and IR in scapula plane
      • Start supine progress to standing
    • Minimize deltoid recruitment (protect acromion!)
    • Use operative extremity for light ADL
    • Scapulothoracic and glenohumeral joint mobilization as needed

 WEEKS 9-12

  • Continue all exercises listed above
  • Periscap and deltoid sub-maximal pain free isotonics
  • AROM with therabands or light weight at varying degrees of trunk elevation
  • Glenohumeral IR and ER sub-maximal pain free isometrics
    • May progress to isotonics with bands    

Criteria for Phase III

  • Improved shoulder function
  • Decreased pain
  • Ability to isotonically activate deltoid and periscap muscles
  • Demonstrates improved strength

PHASE THREE - ACTIVITY PHASE (Weeks 12-16)

 Goals:   

  • Improve strength of shoulder musculature
  • Neuromuscular control of shoulder complex
  • Improve functional activities

Precautions:

  • No sudden or explosive lifting or pulling
  • Limit lifting to 6 lbs

Activity:

  • Continue with all previous exercises
  • Progress strengthening program with resisted forward elevation

PHASE FOUR – HOME THERAPY

  • Continue Home Exercise Program
    • 3-4 times per week as tolerated
    • Continue strengthening
    • Return to functional activity
      • Remember - Reverse Total Shoulder is a low demand construct
      • Return to activity includes light household and work activity

      

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