Reverse Shoulder Arthroplasty Rehab

If you’ve dislocated your shoulder, your orthopedic surgeon might recommend reverse shoulder arthroplasty to repair your joint. If you have surgery to restore your shoulder, you need to take precautions to protect your shoulder and preserve your range of motion while you recover. Everyone recovers from shoulder surgery at their own rate, but you complete four stages of rehabilitation before your surgeon gives you final clearance to return to all activities and sports. 

Rehab Protocols

Phase 1 – Immediate Post Surgical Phase

Phase 1 usually lasts for around 12 weeks, although your surgeon and physical therapist can adjust this time frame depending on your progress. Your goals in phase one are to:

  • Protect your joint and passive range of motion
  • Promote soft tissue healing
  • Gradually increase your range of motion
  • Become able to complete activities of daily living with modifications

Protecting your shoulder

You need to wear your sling continuously for up to six weeks. When you lie supine (flat on your back or front), you need to place a pillow or rolled towel under your shoulder to prevent extension. It would be best if you avoided any active movements, lifting objects, or supporting your body weight with the affected arm.

Days 1-4

You start physical therapy right away. In the first four days, your physical therapist practices passive range of motion (PROM) movements, including the following:

  • Forward flexion and elevation
  • External rotation

You also work on assisted active range of motion (AROM) movements in your neck, elbow, wrist, and hand. You use cryotherapy (ice) for 20 minutes, four or five times a day for the first three days. 

Days 5-21

You continue with your PROM and assisted AROM movements and cryotherapy schedule. You also add submaximal pain-free deltoid isometrics (static holds) to your PT.

Weeks 3-6

You add new PROM movements, including extending the range of your forward flexion and elevation movements and external rotations to your therapy. At six weeks, your therapist can add internal rotation to your exercises. Additionally, you add gentle resistance to your hand, wrist, and elbow exercises.

Your surgeon clears you to start phase 2 of rehabilitation while you can isometrically activate the deltoids and periscapular muscles and tolerate your current PROM and AROM program.

Phase 2 – Early Strengthening Phase

During phase 2, which lasts from week 6-12, your goals are to continue your progress, restore your active range of motion, and reestablish dynamic shoulder stability. During phase 2, you need to take care not to hyperextend your shoulder, lift anything heavier than a coffee cup, or support your body weight with the affected arm.

Weeks 6-8

In phase 2, you and your physical therapist continue to work on your PROM and add:

  • Internal and external rotations of your glenohumeral (GH) (the ball and socket of your shoulder) joint. 
  • Isometric chest and back stabilization exercises
  • GH joint mobilizations

You should be able to use the affected arm for eating and light activities of daily living.

Weeks 9-12

At this stage, you can add 1-3 pound weights to your forward flexion and elevation movements. You also begin gentle internal and external rotation strengthening exercises.

By the end of stage 2, you should have improved shoulder function and demonstrable increased movement and strength in your deltoid and periscapular muscles.

Phase 3 – Moderate Strengthening

Phase 3 usually begins around week 12 and lasts until your surgeon clears you for phase 4. Every patient heals at their own pace, and you may need a month or more to achieve your goals of improving your practical use of your arm and shoulder mechanics, muscular strength, power, and endurance. 

In phase 3, you need to avoid lifting anything heavier than 6 pounds and any sudden lifting or pushing movements. You continue your physical therapy, gradually increasing your range of movement and strength in flexion, extension, and internal and external rotation. 

Phase 4 – Continued Home Program

Finally, usually, around four months after your operation, your surgeon clears you for Phase 4 — your continued home program. By the time you finish phase 3 of your rehabilitation, your physical therapist has given you a home exercise program (HEP) that you practice 3-4 times each week. You work on increasing your strength and progressing toward functional and recreational activities within the safety limitations set by your surgeon and physical therapist. 

When you can demonstrate a full, pain-free active range of motion with proper shoulder mechanics, your surgeon and therapist release you from skilled therapy and give you exercises and stretches to practice at home to continue to strengthen and protect your shoulder as you return to your full range of activities. 

If you’re looking for expert orthopedic shoulder surgeons in the Austin area, contact Dr. Benjamin Szerlip today. We support you before, during, and after your reverse shoulder arthroplasty.