Reverse Total Shoulder Replacement

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Aims:                    

Pain relief form degenerative or post traumatic arthritis with cuff dysfunction

Rotator cuff pseudo paralysis

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Sling:                     

Wear at night up to 3 weeks. Can remove as comfortable in day from 48 hrs         

External rotation as directed by operation note- depends on subscapularis repair

 

Restrictions:          

External rotation as directed by operation note- depends on subscapularis repair

Avoid elbow above shoulder level for 4weeks

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0-1 week:               

Check neurovascular status and post op note

Axillary hygiene

Hand, wrist and elbow active exercises

Gentle pendulums/circles as comfortable

 

1-3weeks:              

Increase pendulums and circling range

External rotation as directed

Active assisted flexion (in internal rotation) up to 90 degrees.

Avoid abduction

Sub-maximal isometrics for deltoid and infraspinatus.

No resisted subscapularis work

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3-6 weeks:             

As range and comfort improves progress to-

Active assisted exercise above 90 degrees- can use pulley.

Adjust relative to patients pre op range.

Scapular setting in neutral.

Closed chain exercises in neutral

Strat strengthening exercises- avoid over loading subscapularis

Gentle progression of external rotation through range

 

After 6 weeks:       

Active exercises through range

Start gentle stretches with ‘hands on’, pulleys, ‘hold and relax’ and self-pressure                                  

Open chain exercises

Scapular control trough range

Proprioceptive exercises

Continue to progress with strengthening programme

 

Driving:                   From 8 weeks as pain allows