Optimizing Rehabilitation Protocols after Reverse Total Shoulder Arthroplasty: A Mini-Review and Clinical Commentary on “A Randomized Single-Blinded Trial of Early Rehabilitation vs. Immobilization after Reverse Total Shoulder Arthroplasty”

Abstract

Despite the increased use of reverse total shoulder arthroplasty (RTSA) as a way to manage patients with rotator cuff tear arthropathy amongst other indications, there is significant heterogeneity in post-operative rehabilitation protocols [1]. Protocols may vary from immediate range of motion (ROM), to restricting some motions such as behind the lower back (combined adduction, internal rotation, and extension), to delayed ROM beyond six weeks [2-5]. As one of the feared complications of RTSA is dislocation, which typically occurs within the first three months post-operatively, many do restrict ROM of the operative shoulder in a shoulder immobilizer to theoretically mitigate the risk of dislocation and subsequent revision procedures [6,7]. However, early immobilization still may not eliminate the risk of early instability after RTSA [8].