KEMBLE WANG - Upper Limb & Trauma Surgeon
MBBS (Hons), FRACS, FAOrthA
Reverse Total Shoulder Replacement
You have just undergone a reverse total shoulder replacement with Kemble Wang. This is a type of shoulder replacement that can be done either for arthritis with tendon problems, or for severe shoulder fractures.
This is a fairly major orthopaedic operation. The main bone and joint surface of the shoulder will have been replacement with an artificial one. The operation is called a 'reverse' shoulder replacement because the ball is replaced with a socket and the socket is replaced with a ball. This 'reversal' of joint surface has mechanical benefits that can improve motion and stability.
The following is an xray of a patient who had a reverse shoulder replacement with Mr Wang.
Postoperatively your arm will be in a sling. You can start coming out of the sling under supervision of the physiotherapist and for prescribed exercises. However, you should remain in the sling most of the time during the first 4 weeks.
Wound and dressing: Your wound will have been closed with absorbable sutures. There will also be dermabond (skin glue) giving additional support. The wound would be covered with a waterproof dressing. You can shower with this wound dressing but do not let it overly soak.
It is normal to have some tingling or numbness or weakness following your procedure. This is often due to a nerve block performed preoperatively to help with your pain, or due to local anaesthetic injected into the wound. This will wear off in the first day or two.
General Information / Goals:
You need time to allow for healing. After 6 weeks postop the recovery is usually 40%, after 12 weeks the recovery is 80%. The last 20% could take 6-12 months
The following is your physiotherapy prescription:
Weeks 0-4: Phase 1 PROM phase
Heat or ice before and after therapy sessions
home exercises 3 times daily.
Weeks 0-2: pendulars, elbow/wrist/hand ROM,
Weeks 2-4: passive ER to 0 deg, scapular strengthening, aquatic therapy ok.
Weeks 4-10: Phase 2 Active ROM phase
Weeks 4-6: Start active assisted ROM (elevation to 90, ER to 0)
Start weaning out of sling at week 4 over a few days
weeks 6-10: Start full active ROM and gentle strengthening - goal is 90+ deg elevation and 30 deg ER
No backward extension or scapular retraction in this phase
Concentric motions only
Weeks 10+: Phase 3 Strengthening phase
Full strengthening, no restrictions
Can start eccentric, plyometric exercises
Modality as per physiotherapist discretion