1. Ashley Webb

2.  initially designed and used in Europe in the late 1980s by Grammont  only received FDA approval for use in the United States in March of 2004.

3.  Rotator Cuff is insufficient and damaged beyond repair  Failed total shoulder replacement  Deltoid muscle becomes the main movement component of the shoulder complex

4.  Structural or neurogenic lesion of the deltoid  Advanced glenoid destruction  Younger then 65 years old

5.  The prosthesis works by: “Medializing the center of rotation of the glenohumeral joint and distializing the insertion of the deltoid muscle, thereby increasing the lever arm”

6.  Good outcomes  WNL for age in all planes of motion EXCEPT for Internal Rotation- with an average gain only at L5

7.  Deltoid repair takes 3-4 weeks to heal  High risk of shoulder dislocation  Avoid any extension past neutral especially combined with internal rotation  Sling worn for first 4-6 weeks

8.  1-3 weeks: PROM flexion to 90, ER to 20-30  3-6 weeks: PROM flexion to 120, ER as tolerated, gentle isometrics  6-12 weeks: continue progressing PROM start Internal Rotation no greater then 50, pt. can start using arm for ADL’s

9.  9-12 weeks: AROM flexion in supine with weights (1-3 lbs.)  12-16 weeks: gentle resisted flexion in standing, no sudden lifting or pushing  Discharge to a HEP when patient is able to perform 80-120 of flexion and 30 of ER

10.  Glenosphere disengagement  24.4% of rTSA  Radiographic follow-up at 3 and 6 months  Revisions in younger patients, if asymptomatic no revision for older patients

12.  Abrahamsen, C. Rehabilitation Protocol After Reverse Total Shoulder  Guery, et.al. 2007 Reverse Total Shoulder Arthroplasty: Survivorship Analysis of Eighty Replacements Followed for Five to Ten Years. Oper Orthop Traumatol.17(1):1-24.  Guery, Favard, Sirveaux, Oudet, Mole, Walch. 2006 Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am. 88(8):1742-7.  Middernaught, De Wilde, Mole, Favard, Debeer. 2008. Glenosphere disengagement. The Association of Bone and Joint Surgeons. 466: 892-897.  Nicholson, G. 2006. Current concepts in reverse shoulder replacement. Current Opinion in Orthopedics. 17(4):306-309.  Replacement.Reverse Total Shoulder Arthroplasty Protocol Copyright © 2007 The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services. All rights reserved.  Walter W, Keyl W. 2005 Reverse total shoulder arthroplasty for the treatment of defect arthropathy. Oper Orthop Traumatol.17(1):1-24.