Reverse Shoulder Protocol

Sling When will I go home? What can I do? What can’t I do?
4 weeks You will be discharged on the day after the operation Range of movement within safe zone* No weight bearing through arm, no forced movements. No lifting

Acute phase (0-4 weeks)

Goals

  • Pain control
  • Protect the shoulder replacement
  • Re-educate optimal deltoid function

Rehabilitation

  • *Safe zone: commence passive range of movement to maximum 90° elevation, 30° external rotation
  • Progress to active assisted and support range of movement within this safe zone
  • No combined external rotation/abduction
  • No extension
  • No hand behind back
  • External rotation control exercises
  • Scapular setting exercises
  • Optimise deltoid function
  • Criteria for progression
  • Pain controlled
  • Deltoid function

Intermediate phase (4-12 weeks)

Goals

  • Restoration of active range of movement
  • Continue to optimise deltoid function
  • Optimise dynamic control through range

Rehabilitation

  • Progress range of movement
  • Progress cuff compensation program (ie. deltoid)
  • Progress rotational exercises
  • Scapular control through range
  • Scapular dissociation/mobility exercises
  • Functional extension and hand behind back exercises
  • Hydrotherapy permitted

Criteria for progression

  • Pain controlled functional range of movement
  • Quality of movement pattern
  • Deltoid function through range
  • Active external rotation control

Late phase (>12 weeks)

Goals

  • Rehabilitate functional specific strength and endurance
  • Aid functional independence

Rehabilitation

  • Function specific strength and endurance
  • Loaded exercises (eccentric & concentric)
  • Internal and external rotation resistance exercises
  • Functional movement pattern re-education
  • Institute home exercise program (for maximum improvement may take up to 2 years to achieve)

Guidelines for return to functional activities

Driving Lifting Swimming Golf
6 weeks Light lifting 6 weeks, avoid heavy until 6 months Breaststroke 8 weeks, freestyle 12 weeks 4 months

 

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