Shoulder and Elbow

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Reverse Shoulder Replacement Postoperative Protocol

Phase I (0-6 weeks): Joint protection

  • Sling for 6 weeks. May come out for showers and exercise.
  • Elbow must be supported by pillow while lying in bed.
  • NO active shoulder movement /May actively move hand, wrist and elbow.
  • Passive ROM exercise
  • Pendulum / Forward flexion 90-120 degrees / External rotation 0-20 degrees.
  • ROM limits will be set by your surgeon and will be explained by the physiotherapist.
  • The use of ice packs 4-5 times per day for 20mins is recommended for the first 7 days.

Phase II (6-12 weeks): Active ROM and early strengthening

  • May wean off sling
  • May use shoulder for self-care and light activities.(e.g. wiping bench, cooking, ironing).
  • Progress PROM exercises and introduce active exercise (e.g. Pulley, walk up wall, bench polishing).
  • Continue to avoid placing your hand behind your back.
  • May not lift anything heavier than a cup of coffee.
  • Massage and gentle joint mobilisations.
  • Progressive strengthening of deltoid as pain allows.

Phase III 12 weeks +

  • Progress strengthening to include weight-bearing and shoulder elevation exercises.
  • May gradually return to gym, recreational activities (e.g. golf, tennis, gardening) over 6 weeks.
  • At 4-6months, patient is able to maintain pain-free shoulder AROM with proper shoulder mechanics.

ROM expectation are typically 80°-120° of elevation, with functional ER of about 30°) IR is more dependent on prosthetic factors such as version and often will have a mechanical block.