Post Operative Reverse Geometry Shoulder Replacement Rehabilitation Protocol
This is an open procedure. The degree of protection that is required post operatively depends on the presence of any tendon repairs or transfers associated with the surgery. Tendon repairs and transfers need to be protected post operatively and should be detailed in the post-operative instructions.
General points
Following the surgery improvement can continue for 18‑24 month’s post‑operatively, it is therefore important to encourage patient to continue with rehabilitation.
The aim of rehabilitation is good quality movement and maximal function.
Do not sacrifice quality of movement and function for range of movement.
Promote normal hand, wrist and elbow function.
Immobilisation
The patient is to wear a sling for 3 weeks, 24 hours a day, only removing for physiotherapy exercises.
At 3 weeks, the patient can be weaned out of sling but should continue to wear the sling at night for a further 3 weeks (total sling usage - 6 weeks at night).
Precautions.
External rotation strength long-term may be compromised as there is decreased leverage of posterior deltoid due to medialisation of the Humerus and the posterior part of the rotator cuff that typically provides external rotation may be deficient or dysfunctional.
To avoid prosthesis instability or dislocation from contact of the humeral component on the scapula, coracoid or acromion, avoid forceful shoulder movements in flexion > 140o, external rotation >45o, internal rotation with hand behind back and horizontal adduction beyond neutral.
Scapular substitution is expected with active range of movement in elevation to maximize efficiency of deltoid.
Lifting weights above shoulder height with more than 2-4 kg should be avoided unless otherwise instructed by the surgeon.
From 0-6 weeks:
Hand, Wrist and Elbow exercises.
Pendular exercises of with gradual progression.
Active assisted elevation in supine as comfort allows.
3 weeks:
Wean out of sling – light activities only.
External Rotation to neutral as comfort allows.
6 weeks:
Start to increase External Rotation. As External Rotation increases, gradually increase elevation range of movement.
Avoid forceful stretching, strengthening or resistance
Exercises.
Avoid overpressure in adduction or flexion>120o.
Avoid combined external rotation and abduction.
Active assisted exercises progressing to active exercises – utilise short lever, supine & Closed Kinetic Chain if appropriate.
No long lever open chain exercises until 8 weeks.
From 8 weeks:
Progress to open chain and long lever – remembering function.
Sub maximal isometrics in neutral – avoiding rotator cuff tendons that have been repaired.
Consider use of the principles of the Deltoid Rehabilitation programme.
From 12 weeks:
Isometrics in variable starting positions progressing to resisted through range and strengthening.
Functional Milestones:
Driving: See general principles of rehabilitation
Swimming: 4 months
Golf: 4 months
Light physical activities work: 6 to 12 weeks.