Rehabilitation and Activity Expectations Following Reverse Shoulder Arthroplasty (RSA)

Rehabilitation recommendations following reverse shoulder arthroplasty (RSA) vary and are not well established in the literature. They range from “doing nothing” to use of a formal physical therapy (PT) protocol involving multiple outpatient visits a week for several months. A significant amount of healthcare resources are spent on postoperative rehabilitation programs; however, their cost-effectiveness and necessity have not been established. Although there are a handful of studies looking at the role of postoperative PT following total shoulder arthroplasty (TSA), a Medline literature search found only one study looking directly at this issue for RSA. The authors recommended a program very similar to their approach to TSA rehabilitation. There were no peer-reviewed studies comparing one program versus another and its effect on outcome. A previous analysis of 2 consecutive groups of patients undergoing TSA for primary osteoarthritis compared formal PT with a home-based, physician-guided PT program. ASES and Simple Shoulder Test (SST) scores significantly improved in both groups at all follow-up periods. Forward flexion and abduction were significantly improved in the home-based group at all time points, whereas an initial improvement in forward flexion and abduction in the formal PT group was lost at the final follow-up. Overall, there was no difference in patient satisfaction. Based on these results, I have continued to rely on a home-based, physician-guided therapy program for RSA postoperative rehabilitation. By focusing on patient-oriented, home-based therapy programs, we allow patients to take full responsibility for their recovery and not rely on an outside agency to be responsible for their result. Based on our early results, this approach works well for many patients; however, supervised PT may still be required for patients who are not progressing as expected. Close physician follow-up and referral to formal PT may be necessary for patients who are not able to meet rehabilitation guidelines on their own. Using this method, outstanding function can be gained following RSA. Full forward elevation and external rotation to greater than 45° is routinely obtained in our patients. The most common limitation of motion is with internal rotation behind the back. Resolution of pain and return to full ADLs are expected of all patients. Return to sports varies based on preoperative participation. Impact sports such as American football, rugby, and hockey are not commonly experienced in this age group, nor are they recommended. Return to sports with primarily lower extremity demands (jogging, hiking, soccer, lower extremity weightlifting) is allowed as desired and tolerated. Return to sports with range of motion below shoulder level (golf, bowling, croquet, boccie, shuffleboard) are expected and encouraged. Limited return to overhead sports, especially those involving contact (tennis, volleyball, badminton, and overhead Australian Crawl swimming), has been successfully returned to by a small number of patients; however, there are too few to make a strong recommendation. Heavy weightlifting above shoulder level should be discouraged.