Reverse Shoulder Arthroplasty with Lat Transfer Rehab Protocol

Keys to a Successful Outcome

  • Early protection of the subscapularis is essential to its integrity.  This is the main reason 4–6 weeks of bracing is required and AROM and strength exercises are delayed until 6 weeks from surgery. 

  • Never over-stress the anterior shoulder/capsule.

  • While lying supine for the first 6 weeks, a small pillow or towel roll should be placed behind the elbow to avoid shoulder hyperextension / anterior capsule stretch / subscapularis stretch.

  • Forceful stretching and mobilization/manipulation is NEVER indicated at any phase of therapy.

Phase
Brace
ROM
WB Status
Exercises
In Hospital
Worn at all times
PROM
NWB
Passive FF while supine, gentle ER in scapular plane to available PROM (documented in Op Note), passive IR. Pendulums.
Weeks 0-6
Worn at all times
PROM
NWB
Elbow/wrist AROM, grip strength, scapula isometrics, PROM goals: FF 90°, ER 45°, IR 90° (at 30° of ABD).
Weeks 6-12
Wean from brace
AAROM/ AROM
1 lb limit
Begin AAROM in plane of scapula, pulleys, sub-max pain-free isometrics in neutral, assisted horizontal adduction. Continue working on PROM.
Weeks 12-16
None
AROM
5 lb limit
Initiate assisted IR, resisted IR/ER in scapular plane, begin supine active elevation strengthening. Progressively increase AROM ranges.
Months 4-6
None
FAROM
10 lb limit
Gradually progress strengthening, return to light recreational hobbies (gardening, light sports activities)
Months 6-12
None
FAROM
15 lb limit
Avoid exercise and functional activities that put stress on the anterior capsule (i.e. combined ER and ABD)

 

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