Reverse Total Shoulder Replacement
Physiotherapy Protocol for REVERSE Total Shoulder Replacement
Phase 1 - PROTECTED MOBILISATION
Days 1-5 (on ward)
Patient independent on ward with sling and dressing management, ADL with or without assistance of carer or family. Sleep and resting position in scapula flexion.
Commence active assisted elevation in supine with a short lever to 90 ͦ. Ensure resolution of interscalene block before commencing exercises.
Standing shoulder blade shrugs
Gentle pendulum swings into flexion from standing. Gentle sliding hand along lap or table – assisted elevation with weight of arm supported.
Days 6 to 14
Continues with above until first physiotherapy out- patient appointment
Supine active assisted flexion progression with a stick. Progress to standing with a stick assisting
Phase 2 - MOVEMENT CONTROL PHASE
Approx. weeks 2 to 6
Continue with active assisted ROM exercises from phase 1.
Sling for busy environments or outdoors. Sleep with sling until 6 weeks. Slowly wean off sling in day.
Active GHJ to 90 ͦin supine to sitting at incline angles of 10 ͦ. (From short lever to long lever)
Gentle static isometric exercises in neutral 20% effort only. Start sagittal - ant/post deltoid then rotation
Active external rotation to 30 ͦ(supine then standing as able)
Supine external and internal isometrics with a stick at neutral then 30 degrees, 60 degrees.
Scapula movement control and re-education as necessary.
Only progress to next stage if pain is controlled and acceptable movement patterns.
Phase 3 - Functional Rehabilitation
Avoid weight bearing through the upper limb. Avoid sudden lifting and pushing of loads.
Weeks 6 to 12
Elevation in supine with 0.5kilo weight.
Loaded GHJ flexion from supine to sitting just using weight of arm.
Standing external and internal rotation with light resistance as patient ability allows.
Resistance yellow tubing pulldowns in sitting.
Loaded GHJ flexion, controlling range and avoiding hyperextension.- use one kilo weights max.
Weeks 12 to 26
Vary and increase repetitions to improve Rotator cuff activation and endurance.
Please do not push external rotation beyond 30 degrees.
The patient may experience impingement beyond 85 degrees abduction therefore it may be appropriate to rehabilitate in the scaption plane. Please avoid hyper extension and HBB until the patient has movement control and can perform without forward translation of humeral head.