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Table 1 Rehabilitation guidelines for reverse total shoulder arthroplasty

From: Protocol for a multicenter, randomised controlled trial of surgeon-directed home therapy vs. outpatient rehabilitation by physical therapists for reverse total shoulder arthroplasty: the SHORT trial

PHASE

PRECAUTIONS AND GUIDELINES

GOALS

EXERCISES

CRITERIA TO ADVANCE TO NEXT PHASE

1

(post-op day 1-2 week)

Sling 24/7 (remove for grooming and HEP-3 5x/day)

Avoid hand behind back, and reaching cross body

Keep arm anterior frontal plane “always see elbow”

No shoulder AROM

No submersion in water

No weight bearing on shoulder

Protect prosthesis from dislocation

Prevent infection

Promote distal circulation

Proper sling fit

PROM: 120 elevation and 30 ER

Pendulum

Active elbow, wrist and hand, scapular retraction

Passive elevation to 90-120 deg in scapular plane

Passive ER to 30 deg inscapular plane

Pain less than 3/10 with PROM

Healing incision without signs of infection

Clearance by MD after radiograph assessment at 2 week check up

2

(3-6 wks)

Sling only in community

Use of operative arm allowed for basic ADLs with elbow beside waist – nothing heavier than a coffee cup. No active reaching from shoulder

May submerge in water (eg pool or hot tub) after 4 weeks

Continue no shoulder extension, hand behind back, cross body or weight bearing

Passive elevation to 120; ER to 30

Able to fire all heads of deltoid

Pain < 3/10

Discontinue elbow, wrist, and hand exs since using arm of ADLs

Continue pendulum, scapular retraction, PROM for elevation and ER 120/30 in scapular plane

ADD: deltoid isometrics for all heads (avoid extension beyond frontal plane)

Reverse pendulum at 90 deg elevation in supine

Passive elevation to 120 and ER to 30 degrees

Able to fire all heads of deltoid without pain

Able to place and hold arm at 90 deg in supine (balanced position)

3

(6-12 wks)

Discontinue sling

Motion recovery without excessive force

Advance arm use in ADLs gradually

May begin hand behind back gently

NO Upper Body Ergometer due to repetitive loading of deltoid on acromion

Optimize PROM

Develop AROM to match available PROM

Establish dynamic stability of shoulder with deltoid and parascapular strengthening, as well as any rotator cuff remaning

Active forward elevation progression: supine to inclined to vertical, short to long lever arm (bent to straight elbow)

Active ER/IR with arm at sideTheraband scapular retraction

IR behind back gently

AROM when upright equals PROM in supine

No pain

Need higher level demand than ADL functions (eg sport or work)

4

(12+ wks)

Avoid heavy lifting and overhead sport

Avoid heavy pushing

May lift light weights for deltoid but not to exceed 3 lbs

NO Upper Body Ergometer

Functional demands for work and/or sport achieved

Gradual increase in deltoid and parascapular muscle strength

Painfree

Weights for deltoid up to 3 lbs max, using short lever arm (bent elbow) for middle deltoid raise

Theraband progression for scapular muscles, including serratus anterior punches

Gentle end range stretching in all planes as part of a daily lifelong routine

NA