Physical Therapy Protocol for Reverse Total Shoulder Replacement

Patients with torn rotator cuffs, certain stages of arthritis or who have had a failed, traditional shoulder replacement are usually good candidates for a reverse total shoulder replacement. This relatively new technique has had a lot of success for patients who have, in the past, lacked other options. More and more surgeons are now practicing this technique.

About Reverse Shoulder Replacement

• Reverse total shoulder replacement is generally done on an inpatient basis. Patients can expect to remain hospitalized for a couple of days following the procedure. During the surgery, the doctor will rebuild the shoulder, changing the shoulder's orientation. The normal socket (glenoid) will be replaced with an artificial ball and the ball (humeral head) will have an implant consisting of a socket, thus reversing the normal structure. This design allows the artificial joint to function when there is no longer a rotator cuff or when the patient has lost a significant amount of bone.

Recovery and Physical Therapy

• Within six to eight weeks after surgery, patients recovering from reverse total shoulder replacement should be able to return to normal activities. During those weeks, patients will follow a three-phase recovery program designed to facilitate the healing of soft tissues. Depending on individual situations, patients may be required to immobilize the arm via a sling for up to six weeks. In other cases, patients may be started on physical therapy right away.

  In the first phase, only gentle movement exercises will be done, such as pendulum exercises. In these, patients allow the arms to dangle and swing, like the action of a clock's pendulum. They may be done standing or while leaning over a chair with one knee on the seat of the chair. The action is to stimulate movement and keep the muscles from freezing. There is no resistance work done during this stage of therapy.

  In the second stage, work with the therapist will begin to include stretching exercises and will focus on increasing the range of motion. The arm can start being used for daily living activities that are not too strenuous. Still no heavy lifting or strengthening exercises.

  During phase three, strengthening exercises begin. Now that the soft tissue has had time to heal, it's time to build back muscles that may have atrophied during recovery. In some cases, muscles may have begun to atrophy prior to surgery if shoulder pain had prohibited arm use. Stretching exercises will continue.