Dr. Jiwu Chen

Sports Medicine Specialist
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Shoulder rehabilitation 12 min read 2026.07.26

Rehabilitation after reverse total shoulder arthroplasty: a phase-by-phase guide

Rehabilitation after reverse total shoulder arthroplasty must balance wound care, implant protection, recovery of motion, and progressive deltoid and periscapular training. This illustrated guide explains common exercises and safety precautions from the first postoperative week through week 12 and beyond.

Author: Dr. Jiwu Chen Medical review: 2026-07-26
Reverse shoulder arthroplastyShoulder rehabilitationPostoperative rehabilitationShoulder range of motionShoulder strengthening

Why is rehabilitation different after reverse shoulder arthroplasty?

Reverse total shoulder arthroplasty switches the positions of the shoulder’s ball and socket, allowing the deltoid to contribute more to arm elevation. It is commonly used for conditions such as a massive irreparable rotator cuff tear with joint disease, a complex fracture, or a failed previous shoulder replacement.

Postoperative rehabilitation must protect implant stability, healing soft tissues, and deltoid function. The surgical approach, any subscapularis or other soft-tissue repair, bone quality, and risk of complications vary between patients, so the time points below are general guides.

Diagram of reverse total shoulder arthroplasty
Reverse total shoulder arthroplasty makes shoulder motion more dependent on the deltoid and periscapular muscles

Four safety principles before you begin

Follow the plan prescribed by your surgeon or rehabilitation clinician. If your individual instructions differ from this guide, follow your clinical plan.

During early recovery, avoid reaching behind your back, shoulder hyperextension, and the combined position of adduction, internal rotation, and extension.

Until your surgeon gives clearance, do not use the operated arm to push up from a bed or chair, support body weight, or lift objects.

Keep every movement slow and controlled. A mild stretch may be acceptable, but stop immediately if you develop sharp pain, marked compensation, or steadily worsening symptoms.

Early recovery: wound care, icing, and sling use

Wound care and dressing changes

Keeping the incision clean and dry helps reduce infection risk. Avoid getting the incision directly wet during early recovery. Showering and suture removal should be guided by wound healing and your surgeon’s instructions.

  • Dressings are commonly changed every 2 to 3 days, and sutures may be removed at about 2 weeks; timing may vary with the closure method.
  • Seek medical care promptly for marked redness, persistent drainage, an unpleasant odor, or fever.

Local icing

Icing can help reduce postoperative pain and swelling. Wrap the ice pack in a clean, dry towel and do not place it directly on the skin.

  • Limit each session to 15 minutes, with at least 2 hours between sessions.
  • If the shoulder becomes painful or swollen after exercise, use ice as directed.
  • Ask your clinician before icing if you have reduced skin sensation, poor circulation, or difficulty sensing temperature.
Icing the shoulder after reverse shoulder arthroplasty
Wrap the ice pack in a dry towel to protect the skin

Shoulder sling

A sling is commonly worn during daily activities and sleep for the first 4 weeks and is usually kept on when outdoors. The forearm should rest beside the body with the abduction pillow supporting it. Your surgeon will determine the exact duration.

  • Do not shorten sling use or change its angle without guidance.
  • If sleep is difficult, ask whether pillows may be used to support the operated arm in a different position.
Correct sling position after reverse shoulder arthroplasty
The sling should support the forearm securely while the shoulder remains relaxed

Rehabilitation timeline at a glance

Recovery can be divided into weeks 0–3, weeks 4–6, weeks 7–12, and after week 12. Progression also depends on pain and swelling, wound status, range of motion, muscle control, and follow-up findings.

Reverse total shoulder arthroplasty rehabilitation timeline
Rehabilitation item Weeks 0–3 Weeks 4–6 Weeks 7–12 Week 12+
Icing Repeated icing Ice after exercise Ice after exercise Ice after exercise
Sling Wear the sling Intermittent use during the day Wear during sleep May discontinue None
Range of motion (Passive) Flexion <90° Abduction <90° External rotation <15° (Passive) Flexion <120° Abduction <120° External rotation <30° (Active) Flexion <140° Abduction <140° External rotation <30° Progress gradually toward full range Avoid flexion or abduction >150° Extension >50° Internal rotation >50°
Reach behind the back ❌ ❌ ❌ ✅
Weight-bearing through the operated arm ❌ ❌ ❌ ✅
Driving ❌ ❌ ❌ ✅
Lifting limit ❌ No heavier than a cup Up to 2 kg Up to 4 kg
Seated table slides Seated elbow flexion/extension Pendulum exercises Wrist and finger mobility ✅ ✅ ✅ ✅
Assisted flexion Assisted external rotation Isometric contractions Shoulder-girdle relaxation ❌ ✅ ✅ ✅
Standing wall climbs Seated stretching Active elbow flexion/extension Side-lying external rotation Supine stretching ❌ ❌ ✅ ✅
Resistance-band exercises Wall ball rolls Supine circles Supine shoulder punch Low row ❌ ❌ ❌ ✅

From week 1: relax the shoulder and move the elbow, wrist, and fingers

The priorities in this phase are protecting the surgical site, controlling symptoms, and maintaining motion in the joints farther down the arm. Shoulder movement should be gentle, without actively lifting the arm.

Seated table slides

Sit at a table and place the operated hand on the surface. Use the table for support while sliding the hand slowly forward and back. Keep the movement smooth and do not increase the range suddenly.

  • 2 to 3 sets per day, 10 to 20 repetitions per set.
Seated table slide for assisted shoulder motion
The table supports the arm and reduces the load on the shoulder

Seated elbow flexion and extension

Sit securely with the operated arm resting on your thigh. Slowly bend and straighten the elbow without swinging or using excessive force.

  • 2 to 3 sets per day, 10 to 20 repetitions per set.
Seated elbow flexion and extension exercise
Keep the shoulder relaxed while the forearm moves slowly

Pendulum exercises

Lean forward and support yourself with the unaffected hand on a table or wall. Let the operated arm hang naturally. Use a gentle body sway to create small circular, forward-and-back, or side-to-side movements without actively swinging the shoulder.

  • 2 to 3 sets per day, 10 to 15 repetitions per set.
Circular shoulder pendulum exercise
Circular pendulum
Forward-and-back shoulder pendulum exercise
Forward-and-back pendulum
Side-to-side shoulder pendulum exercise
Side-to-side pendulum

Wrist and finger mobility

With the shoulder relaxed, rotate and bend the wrist, bring the fingers together, make a fist, and touch the thumb to each fingertip. These movements help maintain mobility and reduce hand swelling.

  • Practice for 3 to 5 minutes each hour.
Wrist, hand, and finger mobility exercises
Wrist, hand, and finger movements

From week 4: assisted motion and scapular stabilization

After clinical clearance, assisted shoulder motion and gentle activation of the periscapular muscles and deltoid can be introduced gradually. Stay within the permitted range.

Supine cane-assisted shoulder flexion

Lie on your back and hold a rigid cane or stick about 80 to 100 cm long with both hands. Use the unaffected arm to guide the operated arm slowly into flexion.

  • 2 to 3 sets per day, 10 to 15 repetitions per set.
Supine cane-assisted shoulder flexion
The unaffected arm guides the operated arm into assisted flexion

Supine cane-assisted external rotation

Lie on your back with the operated elbow bent to about 90 degrees and held close to the trunk. Hold the cane with both hands and use the unaffected hand to push the operated forearm outward slowly. Pause at the permitted limit, then return with control.

  • 2 to 3 sets per day, 10 to 15 repetitions per set.
  • Observe the external-rotation limit prescribed by your surgeon.
Supine cane-assisted shoulder external rotation
Keep the operated upper arm close to the trunk and do not force the range

Shoulder isometrics

Bend the elbow to about 90 degrees. Press the unaffected hand against the outside of the operated forearm and apply gentle opposing pressure without allowing the arm to move. A door frame may also be used under clinician supervision.

  • Hold for 5 to 10 seconds, 10 repetitions per set, 3 sets per day.
Shoulder isometric exercise
An isometric contraction activates the muscle without moving the joint

Scapular retraction and shoulder shrugs

For scapular retraction, gently draw the shoulder blades toward one another while keeping the chest upright. For shrugs, move the operated arm slightly away from the body and slowly raise the shoulder toward the ear. Avoid breath-holding and excessive substitution.

  • Hold for about 5 seconds, 10 repetitions per set, 3 sets per day.
Scapular retraction exercise
Scapular retraction
Shoulder shrug exercise
Slow shoulder shrug

From week 7: gradually restore shoulder range of motion

Active motion can be increased gradually after follow-up clearance. The aim is to recover the functional range needed for daily activities while maintaining coordinated scapulohumeral movement.

Forward and side wall climbs

Face the wall for flexion and stand with the operated side toward the wall for abduction. Walk the fingers slowly upward until you feel a mild stretch, pause, then return to the starting position with control.

  • Hold for about 5 seconds, 10 repetitions per set, 3 sets per day.
Wall climb for shoulder flexion
Face the wall for the flexion wall climb
Wall climb for shoulder abduction
Stand with the operated side toward the wall for the abduction wall climb

Side-lying external rotation

Lie on the unaffected side with the operated elbow bent and the forearm resting in front of the body. Keep the upper arm stable and rotate the forearm outward slowly. Hold briefly, then return with control.

  • Hold for about 5 seconds, 10 repetitions per set, 3 sets per day.
  • Strictly observe any external-rotation restriction prescribed by your surgeon.
Side-lying shoulder external rotation
Avoid using momentum during side-lying external rotation

Supine shoulder abduction

Lie on your back with the operated arm beside the body and the elbow slightly bent. Move the arm slowly out to the side within the permitted range, pause briefly, and return with control.

  • Hold for about 5 seconds, 10 repetitions per set, 3 sets per day.
Supine shoulder abduction exercise
Keep supine abduction slow and controlled

From week 12: strength, control, and stability training

Before beginning strengthening, shoulder motion and muscle control should meet the required criteria, with no persistent pain or swelling after daily activity. Begin with light resistance and increase it gradually.

Multidirectional resistance-band exercises

Stand with one end of the band secured and hold the other end in the operated hand. Within the permitted range, practice flexion, extension, abduction, external rotation, or internal rotation. Choose light resistance that allows good movement quality throughout.

  • 3 sessions per week, 2 to 3 sets per session, 8 to 12 repetitions per set.
Multidirectional shoulder resistance-band exercise one
Multidirectional resistance-band exercise
Multidirectional shoulder resistance-band exercise two
Begin with light resistance

Wall ball rolls

Place the palm lightly on a ball against the wall. Use the shoulder and periscapular muscles to control the ball as it rolls slowly on the wall. Keep the movement stable and pain-free.

  • 3 sessions per week, 3 sets per session, 10 repetitions per set.
Wall ball roll for shoulder control
Wall ball rolls train shoulder control

Supine circles

Lie on your back with the operated elbow slightly bent and the arm raised to the position permitted by your clinician. Make small clockwise and counterclockwise circles, increasing the size gradually while maintaining control.

  • 3 sessions per week, 3 sets per session, 10 repetitions per set.
Supine shoulder circles
Keep the shoulder stable during supine circles

Supine shoulder punch and low row

For the supine punch, keep the elbow straight and lift the shoulder blade to reach the arm upward. For the low row, keep the trunk upright, draw the elbow back slowly, and gently retract the shoulder blade.

  • 3 sessions per week, 3 sets per session, 10 repetitions per set.
  • Do not shrug, twist the trunk, or use sudden force.
Supine shoulder punch exercise
Supine shoulder punch
Low-row exercise
Low row

When should you stop exercising and seek review?

Recovery rates vary. At each follow-up, report pain, swelling, sleep, and response to daily activities and exercises. The care team can then adjust the exercise, frequency, or phase as needed.

Redness, drainage, an unpleasant odor from the wound, or fever.

Shoulder pain or swelling that is clearly worsening and does not settle with rest and icing.

A sudden pop, a sense that the joint has shifted, or sudden inability to raise the arm.

Persistent numbness, color change, marked swelling, or weakness in the arm or fingers.

Exercises can only be completed with marked shrugging, trunk leaning, or other compensation.

All content is for medical education only and cannot replace an in-person medical evaluation or an individualized treatment plan.

References

Shoulder rehabilitation | Postoperative rehabilitation program after reverse total shoulder arthroplasty — Gongji Sports Medicine (Chinese) Massachusetts General Hospital — Rehabilitation Protocol for Reverse Shoulder Arthroplasty AAOS OrthoInfo — Reverse Total Shoulder Replacement Brigham and Women’s Hospital — Reverse Total Shoulder Arthroplasty Guideline
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