Reverse Shoulder Replacement
Indications:
- Massive Irrepairable Rotator Cuff Repair or Cuff Tear Arthropathy
- Shoulder arthritis in the absence of a functional rotator cuff.
Protocol:
INPATIENT
Day 0
- Polysling with body belt fitted in theatre
- Finger, wrist and elbow movements
- Occupational Therapy
Day 1
- Body belt removed
- Axillary hygiene taught
- Pendular exercises
- Scapular setting
- Passive flexion in the scapula plane as comfortable
- External rotation to neutral
- Discharge usually at day 1 or 2
OUTPATIENT
Day 5 to 3 weeks
- No resisted internal rotation or forced passive external rotation (reattached subscapularis muscle is vulnerable)
- Begin passive abduction (maintain shoulder in IR)
- Passive external rotation to neutral only
- Active assisted flexion in supine and progress to sitting position as soon as the patient is able.
- Progress to active when possible
- Begin isometric strengthening of all muscle groups (except IR)
- Remove sling as able
- Functional reaching activities below 90 degrees
3 weeks +
- Encourage active movement into all ranges with some gentle self-stretching at the end of range.
- Add isometric IR
- Progress functional activities
6 Weeks +
- Progress strengthening through range
- Regularly stretch the joint to the end of its available range
- Soft tissue manipulation if required
Milestones
Week 3
- 50% of pre-op active ROM
Week 6
- Passive ROM to at least pre-op level
Week 12
- Active ROM to at least pre-op level
Improvement continues for 18 months to 2 years and the patients should continue exercising until their maximum potential has been reached
Return to functional activities
Driving
- 6 Weeks
Swimming
- Breaststroke: 6 weeks
- Freestyle: 3 months
Lifting
- 3 Months (then guided by the strength of the individual patient)
Return to work
- Sedentary job: 3 weeks
- Manual job: Guided by Surgeon may be between 3 - 6 months.
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