Reverse Shoulder Arthroplasty with Lat Transfer Rehab Protocol

Keys to a Successful Outcome

Early protection of the subscapularis is essential to its integrity. This is the main reason 4–6 weeks of bracing is required and AROM and strength exercises are delayed until 6 weeks from surgery.
Never over-stress the anterior shoulder/capsule.
While lying supine for the first 6 weeks, a small pillow or towel roll should be placed behind the elbow to avoid shoulder hyperextension / anterior capsule stretch / subscapularis stretch.
Forceful stretching and mobilization/manipulation is NEVER indicated at any phase of therapy.

Phase	Brace	ROM	WB Status	Exercises
In Hospital	Worn at all times	PROM	NWB	Passive FF while supine, gentle ER in scapular plane to available PROM (documented in Op Note), passive IR. Pendulums.
Weeks 0-6	Worn at all times	PROM	NWB	Elbow/wrist AROM, grip strength, scapula isometrics, PROM goals: FF 90°, ER 45°, IR 90° (at 30° of ABD).
Weeks 6-12	Wean from brace	AAROM/ AROM	1 lb limit	Begin AAROM in plane of scapula, pulleys, sub-max pain-free isometrics in neutral, assisted horizontal adduction. Continue working on PROM.
Weeks 12-16	None	AROM	5 lb limit	Initiate assisted IR, resisted IR/ER in scapular plane, begin supine active elevation strengthening. Progressively increase AROM ranges.
Months 4-6	None	FAROM	10 lb limit	Gradually progress strengthening, return to light recreational hobbies (gardening, light sports activities)
Months 6-12	None	FAROM	15 lb limit	Avoid exercise and functional activities that put stress on the anterior capsule (i.e. combined ER and ABD)

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