Postoperative Rehabilitation After Shoulder Arthroplasty

Abstract

Rehabilitation after total shoulder arthroplasty (TSA) should be tailored to the biomechanical principles and soft‐tissue considerations unique to each form of total shoulder arthroplasty. Anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) each require distinct rehabilitation strategies with considerations based on implant design, muscular force couples, and the need to protect associated soft‐tissue repairs. A phase‐based framework provides a practical approach for guiding postoperative recovery while minimizing complications and optimizing timely return to activity. The immediate postoperative phase emphasizes protection of soft tissues, pain control, and restoration of passive mobility. After aTSA, rehabilitation prioritizes protection of the subscapularis repair with immobilization and passive range of motion, limiting excessive external rotation and active internal rotation. In contrast, rehabilitation after rTSA allows for accelerated mobilization with focus on instability prevention and early deltoid activation with assisted forward elevation. Sling‐free range of motion after rTSA with lateralized components and no subscapularis repair is safe with comparable outcomes to more traditional rehabilitation. During the transitional phase, active range of motion progresses. Rotator cuff and scapular stabilization exercises are emphasized after aTSA to restore native shoulder biomechanics, whereas rTSA rehabilitation focuses on deltoid‐based strengthening and neuromuscular control to compensate for rotator cuff deficiency. As mobility and strength improve, patients transition toward functional tasks and overhead reach. The final phase focuses on progressive strengthening, endurance training, and return to recreational activities. Many patients are able to resume low‐impact sports once functional strength and motion are restored. For golfers, progression begins with short‐game activities before advancing to full swing as strength and motion recover. Most patients resume unrestricted golf 5 to 6 months after total shoulder arthroplasty, with earlier phases introduced in a staged manner. Return‐to‐golf rates are higher after aTSA (78%) compared with rTSA (59%), although both allow recreational golfers to return to play at similar performance levels (94%) after recovery.