REVERSE Total Shoulder Replacement

Physiotherapy Protocol




Days 1-5(on ward)

  • Patient independent on ward with sling and dressing management, ADL with or without assistance of carer or family. Sleep and resting position in scapula flexion.
  • Commence active assisted elevation in supine with a short lever to 90 ͦ. Ensure resolution of interscalene block before commencing exercises.
  • Standing shoulder blade shrugs
  • Gentle pendulum swings into flexion from standing

Days 6 to 14

  • Continues with above until first physiotherapy out- patient appointment
  • Supine active assisted flexion progression with a stick
  • Supine 90 ͦglenohumeral joint static joint holds

If able to control 90 ͦstatic hold in supine can progress to next stage.




Approx. weeks 2 to 6

  • Continue with active assisted ROM exercises from phase 1
  • Sling for busy environments or outdoors. Sleep with sling until 6 weeks. Slowly wean off sling in day
  • Active GHJ to 90 ͦin supine to sitting at incline angles of 10 ͦ. (From short lever to long lever)
  • Gentle rhythmic stabilisation at 90 ͦ GHJ flexion. 20% effort only. Start sagittal then rotation
  • Active external rotation to 30 ͦ(supine to side lying as able)
  • Supine external and internal isometrics with a stick
  • Scapula movement control and re education as necessary.

Only progress to next stage if pain is controlled and acceptable movement patterns


Phase 3: Functional Rehabilitation

Avoid weightbearing through the upper limb Avoid sudden lifting and pushing of loads


Weeks 6 to 12

  • Elevation in supine with 0.5kilo weight
  • Loaded GHJ flexion from supine to sitting
  • Standing external and internal rotation with resistance as patient ability allows.
  • Resistance yellow tubing pulldowns in sitting
  • Resisted GHJ flexion, controlling range and avoiding hyperextention.

Weeks 12 to 26

  • Vary and increase repetitions to improve strength and endurance

Please do not push external rotation beyond 30 degrees.

The patient may experience impingement beyond 85 degrees abduction therefore it may be appropriate to rehabilitate in the scaption plane.

Please avoid hyper extention and HBB until the patient has movement control and can perform