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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