Reverse Shoulder Replacement

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  • 6-10 Visits over 4 months
  • Reverse Total Shoulder Replacements are especially susceptible to dislocation during internal rotation, glenohumeral extension, and during an axial load on humerus (such as when pushing oneself up out of bed, pushing up out of a chair with hand behind body, and during extreme external rotation). Care must be taken to avoid such positions.
  • Patients who have had a Reverse Total Shoulder Replacement are considered rotator cuff deficient
  • Emphasis will eventually be on a AAROM and a high repetition, low weight free weight program
  • Address scapular mal-positioning if indicated
  • Minimal to no pain during or after exercises, although fatigue is OK
  • No passive ROM (PROM) or pulleys unless specifically indicated by the physician

Subscapularis Repair Precautions:

  • No active IR or glenohumeral extension beyond midaxillary line for 6 weeks; no resisted IR until 12 weeks post-op.
  • ER at 0 o or less until 4 weeks post-op., 20 o or less until 8 weeks post-op., and near symmetric by 4 months post-op.; no ER in abduction beyond neutral for 6 weeks post-op.

Biceps Tenodesis Precautions:

  • No active elbow flexion or supination against resistance for 4 weeks
    • Modalities:
      1. Ice following exercises
      2. No phonophoresis/iontophoresis
      3. No ultrasound
      4. Transfrictional massage for tendonitis (only if indicated by physician)
      5. Soft-tissue techniques (only if indicated by physician)

Stage I (0-6 weeks)

No physical therapy initiated until 5 weeks post-operatively

  1. A sling is to be worn for 6 weeks, and should not be removed except for elbow ROM exercises.
  2. There should be absolutely no shoulder activity for 4 weeks except tabletop activities in neutral..
  3. Stretching:
    1. Active elbow, wrist, and hand ROM 3-4 times per day
    2. Begin Codman’s exercises at 2 weeks post-operatively
  4. Goals: Protect replacement during the early phase of healing

Initiate formal physical therapy at the 5 weeks post-operatively Discontinue wearing sling at 6 weeks unless otherwise indicated

  1. Stretching:
    1. Codman’s 4-5 times per day for 5 minutes
    2. AAROM (wand exercises) except ER – No ER until 6 weeks
  2. Scapular stabilization exercise #1
  3. Goals: Continue to protect replacement during the early phase of healing, initiate Codman exercises and AAROM exercises

Stage III (weeks 7-12)

Focus on all 3 heads of deltoid

  1. Stretching/ ROM:
    1. Codman’s (pendulum) exercises
    2. AAROM (wand exercises) with ER to 30° max.
  2. Strengthening:
    1. Isometrics
    2. Supine program (exercises #1-6) – progress to vertical against gravity
  3. Scapular stabilization exercises #1-7
  4. Goals:
    Progress with AAROM as indicated and initiate strengthening program

Stage IV (weeks 12+)

Discontinue isometrics

  1. Stretching:
    1. Codman’s to warm up
  2. Strengthening:
    1. Isotonic strengthening exercises #1-8 as tolerated
      1. Perform with free weights only (No theraband - except IR #6)
        1. Repetitions – 20-50 reps before adding/progressing in weight
        2. Start against gravity without weight; progress as tolerated to:
          1. 2 oz. (dinner knife)
          2. 4 oz. (tuna can)
          3. 8 oz. (soup can)
          4. 1 lb. weight
          5. 2 lbs. weight, etc./li>
  3. General Information:
    1. Isotonic strengthening exercises should be encouraged 1-2x/week for 3-6 months
    2. Functional lifting restriction is 20# for lifetime
  4. Goals: Resume functional activities as allowed by the physician

This protocol provides you with general guidelines for the rehabilitation of the patient with a reverse total shoulder replacement. Specific changes in the program will be made by the physician as appropriate for an individual patient.

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