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REHAB PROTOCOL · SHOULDER
Reverse Total Shoulder Replacement Protocol
By Dr. Shayne Kelly, DO — Fellowship-Trained Sports Medicine Surgeon · Tri-City Orthopedics, Kennewick, WA
The written protocol Dr. Kelly provides to his patients and their physical therapists in the Tri-Cities. Time frames are guidelines — progression is criteria-based, and your own post-op instructions always govern.
Educational information, not medical advice. This is not a substitute for the specific instructions Dr. Kelly and your physical therapist give you. Your timeline depends on your surgery, your body, and your progress. Follow your own care team's directions. In an emergency, call 911.
Protective Phase | Weeks 3 to 6
Strengthening Phase | Weeks 6 to 12
Functional Phase | Weeks 12+
| Reverse Total Shoulder Post Op Protocol |
| • | Week 1–2 with abduction pillow and sling, 24 hours/day |
| • | Week 2–4, sling at 24 hours/day |
| • | Gradually wean from sling between weeks 4–6 |
| During PT and during exercise, sling purposefully removed |
| May be extended in case of a complication or in revision RSTA case |
MOVEMENT PRECAUTION (12 WEEKS)
- •No extension beyond neutral; no adduction + IR combined motions; no extension + IR combined motion mobilizations:
- •With RTSA, No mobilizations through GH junction directly at any time throughout rehabilitation
- •Anatomical center of rotation shifted and convex/concave rule for
- •Arthrokinematics are not applicable, so standard mobilizations are not appropriate
- •Poor Bone Stock: Will delay start of protocol second to surgeon’s assessment of repair integrity; acute phase | post-op – days 1 to 5
- •Goals: Promote patient comfort by controlling pain, promote joint healing, specifically soft tissues such as the deltoid
- •Patient/family independence with joint protection, PROM, assisting with on/off of
- •Clothing, modalities and assistance with prescribed HEP; gradual increase PROM of shoulder
- •Restore AAROM of elbow/wrist/hand; postural awareness
- •No AROM, lifting, sudden movements, stretching of operative extremity
MODALITIES
- •Ice application 4–5 times/day for 15–20 minutes; sub-acute phase | post-op – days 5 to 3 weeks
- •Goals: Promote patient comfort by controlling pain, promote joint healing, specifically soft tissues such as the deltoid
- •PROM continued, manual therapy for general shoulder PROM; appropriate progression of A/AAROM of elbow, wrist, hand
- •Supine Self PROM into flexion; sub-maximal periscapular isometrics initiated
- •Reinforce patient education with regard to use of abduction pillow
- •Cervical AROM program with emphasis on maintenance of neutral posture
- •Modalities: continue PRN
Protective Phase | Weeks 3 to 6
- •Goals: Facilitate healing of soft tissues local to joint, protect deltoid and restore/maintain PROM Range of Motion:
- •
- •PROM guidelines – Scapular plane elevation not to exceed 120, ER at 30° abduction to 30–45°, IR at 30° abduction to 30–45°, grade I-II scapular mobilization, all planes
THERAPEUTIC EXERCISE
- •Submaximal RC and periscapular stabilizer isometrics Modalities:
- •Interferential electrical stimulation and cryotherapy for pain modulation; FES for muscle re-education
- •Ultrasound/phonophoresis for control of inflammation
WEEKS 5 TO 6
- •May progress AAROM activities, including wand/pulleys, initiate UBE AAROM.
- •Ensure continued HEP compliance and wean from utilization of immobilizer, as tolerated.
GOALS Joint protection
Strengthening Phase | Weeks 6 to 12
- •Goals: Initiate light strengthening, proprioception and periscapular stabilization, control pain/swelling Range of Motion:
- •Continue PROM scapular plane elevation to 130+°, ER/IR to Torrance at 30° abduction, grade II-III scapular mobilization, all planes Therapeutic exercises:
- •Isotonic periscapular progression, light isotonic RC progression with high volume and low intensity, remember that minimal isolated IR/ER will exist to neutral position
- •Considerations: avoid hyperextension
- •Modalities: continue PRN
GOALS Restore AROM
Functional Phase | Weeks 12+
- •Goals: Focus on progressive strengthening to restore force couple mechanics, enhance dynamic stabilization/neuromuscular control and increase strength, power, and endurance to promote optimal tolerance to functional activity Range of Motion:
- •Continue PROM scapular plane elevation to tolerance, ER/IR to tolerance at 30° abduction, grade III scapular mobilization all planes Therapeutic Exercise:
- •Progression of AA exercises (UBE, proprioception and CKC mobility exercises, e.g., body blade, physio ball)
- •Progression of periscapular activation with TheraBand; progression of gentle GH IR and ER isotonic strengthening
- •Progression of deltoid strengthening exercises; progression wrist/hand/elbow exercises with resistance
- •Maintain high volume and gradually increase intensity levels
- •Modalities: continue PRN; discharge criteria; patients to complete HEP 3 to 4x a week
- •Painless AROM to be grossly WNL’s compared contralaterally
- •MMT grade grossly 4/5 with flexion, abduction strength minimally, ideally 4+ to 5/5
RETURN TO ACTIVITY
- •Sedentary job – 4 to 6 weeks; stationary bike for exercise – 3 weeks; treadmill/walking aggressive for exercise – 9 weeks
- •Driving – as early as 6 to 9 weeks; swimming – breaststroke 9 weeks, depending on progress
- •Tennis, golf 12 weeks, depending on progress; running 12 weeks
GOALS Independent ADLs
Discharge Criteria & Long-Term Precautions
- •Independent ADLs within expected functional ROM; independent home program
- •Long-term joint protection reviewed (avoid combined IR + adduction + extension early; lifting limits per Dr. Kelly)
Time frames are guidelines — progress when phase goals are met, per Dr. Kelly and the treating therapist.
