At a recent journal club, we reviewed some of the literature (see links below) regarding guidelines for rehabilitation after reverse total shoulder arthroplasty. Combining this review with our own experience, we came up with the following:
1. The postoperative rehabilitation program may need to be customized based on
a. Preoperative assessment: what is the patient's risk of falling? does the patient use ambulatory aids such as a walker? what sort of family/friend/professional support does the patient have for the postoperative period of recovery? can the patient get out of bed without using the operative arm for support? how strong is the deltoid?
b. Intraoperative assessment: how stable is the shoulder in positions necessary for activities of daily living? is subscapularis repair part of the procedure?
2. For most RTSAs the rehabilitation program for the first six weeks can be simplified as follows
a. While an ordinary sling can be used to rest the arm, strict immobilization is not necessary; tying the arm up in a sling may interfere with balance.
b. Resumption of activities with the hand in front of the body - such as eating, teeth brushing, washing face - is encouraged as soon as the shoulder is comfortable. These activities improve proprioception and muscle tone.
c. Use of a walker is encouraged if necessary for balance; fall prevention is a priority
d. Extension, adduction and internal rotation (such as in pushing up from a bed or chair) should be avoided at least for the first 6 weeks. A bed with adjustable height and a trapeze for the opposite arm may be helpful.
e. Range of motion exercises are usually unnecessary
f. Deltoid strengthening (see this link) is delayed until 6 weeks post op - especially if the subscapularis has been repaired.
3. After six weeks additional activities of daily living are added as comfort allows. Patients are cautioned about falling as well as the risk of acromial or stress fractures.
A randomized single-blinded trial of early rehabilitation versus immobilization after reverse total shoulder arthroplasty
Rehabilitation After Anatomic and Reverse Total Shoulder Arthroplasty
Accelerated rehabilitation following reverse total shoulder arthroplasty
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Here are some videos that are of shoulder interest
