🔴 Dislocation Precautions: Follow for Minimum 10–12 Weeks
- Avoid: The combination of shoulder extension + adduction + internal rotation together: this is the position that dislocates a reverse shoulder
- Avoid: Reaching behind your back (back pocket, tucking shirt in)
- Avoid: Lying flat without a towel roll under the elbow: shoulder must be slightly forward at all times when lying
- Avoid: Pushing up from a chair or bed with the operated arm
- Avoid: Sudden jerking, pulling, or throwing movements
- Always be mindful of these positions even beyond 12 weeks
🔑 Why Reverse TSA is Different from Standard TSA
- In a reverse TSA, the ball and socket are swapped: this re-routes the deltoid to lift the arm instead of the rotator cuff
- The rotator cuff is absent or irreparable: the deltoid is the primary focus of rehabilitation
- Expected ROM is typically 90–120° elevation: not full overhead range in most patients
- Dislocation risk is higher than standard TSA: respect precautions strictly
- If tendon transfer was performed (latissimus dorsi or lower trapezius): your protocol will be slightly delayed; confirm with Dr. Satish Reddy
Phase 1
Strict Protection Phase
Week 0 – Week 6🎯 Goals
- Protect the implant from dislocation
- Control pain and swelling
- Keep elbow, wrist and hand moving
- Begin gentle scapular activation
- Understand and follow dislocation precautions
⚠️ Precautions
- Sling at all times (4–6 weeks): day and night except showering and exercises
- No active shoulder movement
- No lifting with operated arm
- No pushing up from chair or bed with operated arm
- Elbow must be visible when lying down: support with towel/pillow
- Keep wound dry: no soaking for 2 weeks
Exercises: Week 0–6
- Elbow bending and straightening: full range slowly
- Wrist circles and flexion/extension
- Finger bending and squeezing
- Scapular retractions: gently squeeze shoulder blades in sling
- Shoulder hang (isolated rTSA only): lean forward, arm hangs freely: no active movement
- Table slide (isolated rTSA only): sit, slide arm forward on cloth
- Assisted elevation with stick (Week 4+, isolated rTSA): good arm guides bad arm gently overhead
- Chin tucks: 5-sec holds
- Ice 3–5 times daily
✅ Ready for Phase 2 When:
- Understanding and compliance with dislocation precautions
- Progressing shoulder passive/assisted ROM (isolated rTSA)
- Independent with home exercises
Phase 2
Active Range of Motion & Early Deltoid Activation
Week 7 – Week 12🎯 Goals
- Continue dislocation precautions
- Progress assisted and active shoulder movement
- Activate deltoid and scapular muscles
- Progress to active shoulder movement
- Begin weaning off sling
Exercises
- Assisted elevation (lawn chair progression): lying, use stick, then towel, then unassisted
- Active shoulder flexion: lying, arm up overhead slowly
- Rail slide/wall slide: slide arm up railing or wall
- Assisted ER with cane: gentle outward rotation, elbow bent
- Deltoid isometrics: flexion, abduction, adduction at wall
- Scapular retractions, standing
- No resistance with tendon transfer: until Week 12
✅ Ready for Phase 3 When:
- Improving functional use of shoulder in daily tasks
- Can isometrically activate all parts of deltoid and scapular muscles
- Active shoulder flexion progressing (aim 90° in standing by Week 12)
Phase 3
Progressive Functional Strengthening
Week 12 – Week 20🎯 Goals
- Shoulder elevation 90–120° actively in standing
- Good scapular control and shoulder mechanics
- Begin resistance exercises
- Return to light household and daily tasks
Exercises
- Active shoulder flexion standing: raise arm in front, elbow straight
- Wall slide standing: slide arm up wall slowly
- Resistance band rows: seated and standing (light resistance)
- Resistance band shoulder extension
- ER and IR with resistance band (begin tendon transfer patients here)
- Serratus anterior protraction
- Biceps curls and triceps extension
- Scapular Ws, Ts, Ys: prone
🏠 Daily Life
- Driving: Week 8–10 once off sling: surgeon clearance; off strong painkillers
- Two-wheeler: Month 4+: confirm with surgeon
- Light housework: Week 10–12: no reaching behind back, no heavy lifting
- Office work: Week 6–8 with sling; operated arm resting
- Lifting limit: No more than 0.5–1 kg until surgeon clears beyond this
Phase 4
Home Programme & Return to Activity
Month 4 onwards🎯 Goals
- Return to light household and work activities
- Return to recreational activities within surgeon-defined limits
- Independent with home exercise programme
- Maintain dislocation awareness permanently
Long-term Programme
- Continue all Phase 3 exercises: 3 times/week lifelong
- Gradually increase resistance as tolerated
- Activity-specific training as needed
- Report any new clicking, catching, or instability early
Activity Guide
| Activity | Allowed? | When | Notes |
|---|---|---|---|
| Sling use | REQUIRED | 4–6 weeks | Day and night; always except showering and exercises |
| Elbow/wrist/hand movement | YES | Day 1 | Keep distal joints moving at all times |
| Light one-arm daily tasks | CAUTION | Week 1 | No operated arm active shoulder movement; good arm does the work |
| Driving | WAIT | Week 8–10 | Off sling, surgeon clearance, off strong painkillers |
| Two-wheeler | WAIT | Month 4+ | Risk of fall; confirm with surgeon |
| Office/desk work | CAUTION | Week 6–8 | Operated arm resting; no active shoulder tasks |
| Light housework | CAUTION | Week 10–12 | No reaching behind back, no heavy tasks |
| Lifting (<0.5–1 kg) | CAUTION | Month 3+ | Surgeon clearance; no sudden lifts |
| Overhead reaching | CAUTION | Month 3+ | Within comfortable range only; do not force |
| Swimming | WAIT | Month 4+ | Gentle strokes; avoid breaststroke; surgeon clearance |
| Cricket batting / overhead sport | WAIT | Month 6+ | Surgeon clearance; may have permanent limits |
| Reaching behind back | AVOID | 10–12 weeks minimum | Dislocation risk: the most dangerous position for rTSA |
| Pushing up from chair with operated arm | AVOID | 10–12 weeks minimum | Major dislocation risk: use good arm only |
🚨 When to Contact Us
🔴 Come to Hospital Immediately
- Sudden severe pain with arm appearing in an abnormal position
- Feeling or sound of shoulder "coming out"
- High fever with wound redness, swelling, or discharge
- Arm becomes cold, pale, or numb suddenly
🟡 Call Clinic Within 24 Hours
- New pain or significant increase in pain
- Wound not healing or looking infected
- Shoulder stiffness not improving
- Any new clicking, catching, or instability sensation
📅 Follow-up Schedule
🗓 Clinic Reviews
- 2 weeks: Wound check, suture removal
- 6 weeks: ROM, sling weaning, X-ray
- 3 months: Strength and function review
- 6 months: Full functional assessment
- 1 year: Annual X-ray and review
⚠️ Long-term Advice
- Home programme 3 times/week: lifelong
- Permanent weight limit: typically 1–2 kg unless cleared
- Always be mindful of dislocation positions
- Annual review to monitor implant
🏠 Daily Life Tips
- Sleep on back: towel roll under operated elbow
- Dress operated arm first, undress last
- Never reach behind back without care
- Use long-handled tools early on for dressing/bathing