Postoperative rehabilitation program

All patients underwent a postoperative rehabilitation protocol prescribed by their treating surgeon, all of which were similar and followed the same principles and guidelines.

For anatomic TSA, Phase I consists of passive motion for the first 6 weeks postoperatively. A sling is worn at all times for the first 2 weeks, after which it is weaned until week 6 when it is discontinued entirely. Supine well-arm assisted passive range of motion is emphasized in all planes as allowed per the safe zone specified by the surgeon based on intraoperative findings. Phase II (6-12 weeks postoperatively) consists of active range of motion with the goal to achieve full range of motion by the end of week 10. Resisted internal rotation is begun at 10 weeks postoperatively. Light resistance and aquatic therapy may be initiated in this phase. After 10 weeks, the patient enters Phase III which consists of final strengthening and increasing functional activities, given the achievement of acceptable motion.

For reverse TSA, a sling is worn at all times during the first 2 weeks postoperatively. During this phase, the goal is to increase passive range of motion for elevation to 120° and external rotation to 30°. During Phase II (2-6 weeks postoperatively), the sling may be removed and the arm may be used for activities of daily living. Weight bearing is protected and dislocation precautions are maintained. Submaximal isometrics for the deltoid are initiated and full passive range of motion is achieved. During phase III (6 weeks-3 months postoperatively), the sling is discontinued completely and passive external rotation is allowed to advance beyond 30°. Active range of motion is initiated and optimized. After 3 months postoperatively, rehabilitation consists of optimizing functional use of the extremity and increasing strength/resistance training to meet the demands of the patient’s work tasks, hobbies, and activities of daily living.