Reverse Polarity Shoulder Arthroplasty Rehabilitation Guidelines

Reverse Polarity Shoulder Arthroplasty Rehabilitation Guidelines

Introduction

Reverse shoulder arthroplasty alters the mechanics of the shoulder by reversing the orientation of the joint. This modification allows the deltoid muscle to take on a more significant role in arm movement, compensating for the absence or dysfunction of the rotator cuff or in cases of significant bone loss.

These guidelines aim to:

• Protect the prosthesis.
• Promote soft-tissue healing.
• Gradually restore mobility, strength, and function.

All exercises should be pain-free and tailored to the patient. For post-operative specifics, contact the consultant’s secretary.

Rehabilitation Phases

Phase 1: 1–21 Days

Goals:

• Protect the Prosthesis and Soft Tissues:
  • Use a sling at all times except for hygiene or exercises.
  • Teach sling use, dressing, and hygiene techniques.
• Pain and Inflammation Management:
  • Employ analgesics, NSAIDs, ice, and proper posture.
• Regain Gentle Mobility:
  • Shoulder pendulum exercises and PROM for hygiene/dressing.
  • Maintain ROM for hand, wrist, elbow, and neck.
• Scapular Control:
  • Focus on retraction and depression.
• Wound Care:
  • Keep wounds clean/dry and begin scar massage after stitches are removed.
• Sleeping Advice:
  • Wear a sling during sleep; support the elbow with a pillow to prevent extension.

Precautions:

• Wear the sling for 4–6 weeks.
• Avoid:
  • Combined abduction and external rotation.
  • Lifting, excessive stretching, or sudden movements.
  • Supporting body weight on the operated arm.
  • Driving for 6 weeks.

Phase 2: 4–8 Weeks

Goals:

• Soft Tissue Healing:
  • Continue PROM and gradually progress to AAROM and AROM.
  • Focus on scapular-humeral rhythm (SHR) for stability.
• Strengthening:
  • Begin isometric exercises, progressing to light isotonic strengthening.
• Posture and Function:
  • Promote postural awareness and gradual return to light, non-repetitive activities.

Precautions:

• Wean out of the sling after 4–6 weeks.
• Avoid:
  • Combined abduction and external rotation.
  • Heavy lifting or repetitive upper limb activities.
  • Driving until 6–8 weeks (right vs. left shoulder).

Milestones:

• At 4 weeks:
  • Pain and inflammation well-managed.
  • Return to pre-op sleep patterns.
  • Established good scapular setting.
• At 8 weeks:
  • Pain-free AAROM: Flexion 90°, external rotation 30°.
  • Good SHR with PROM.

Phase 3: 9–14 Weeks

Goals:

• Maximise Mobility:
  • Achieve full PROM and progress AROM with good SHR.
• Strengthening:
  • Gradually introduce:
    • Cuff strengthening.
    • Scapular stabilisation exercises.
    • Proprioceptive and dynamic stabilisation exercises.
• Functional Progression:
  • Begin light sport-specific and functional activities as tolerated.

Precautions:

• Avoid excessive shoulder loading, heavy lifting, and prolonged overhead activities.

Phase 4: 3–6 Months

Goals:

• Maintain Full PROM and AROM:
  • Include multidirectional stretches and end-range stretching.
• Strength and Stability:
  • Continue strengthening of the cuff, scapular stabilisers, and biceps.
  • Progress to dynamic and rhythmic stabilisation exercises.
• Functional and Sport-Specific Activities:
  • Gradually increase demands based on patient goals and recovery.

Precautions:

• Avoid:
  • Heavy lifting away from the body.
  • Prolonged, repetitive overhead tasks.

Milestones at 14 Weeks:

• Pain-free AROM to 100% of pre-operative range.
• Passive external rotation to 100% pre-op range.

Phase 5: 6–12 Months

Goals:

• Strength and Function:
  • Maintain progress in PROM, AROM, and strength.
  • Return to strenuous activities and contact sports as needed.

Milestones at 6 Months:

• Full pain-free motion and rotator cuff strength restored.

Contact Information

• Consultant Secretary: 07810356433
• Physiotherapy at Sulis Hospital: 01761 422388
• Circle Health Group Bath Clinic Physiotherapy: 01225 838767
• St. Joseph Physiotherapy: 01633 820321

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