What is a Total Shoulder Replacement (TSA) vs Reverse Total Shoulder Replacement (reverse TSA)?

  • The need for these surgeries will be determined by your orthopedic surgeon and typically indicated because of a high level of arthritis in the shoulder. TSA and Reverse TSA will depend on the integrity of your RTC.  Successful TSA’s rely heavily on your RTC being intact.  If you are suffering from advanced arthritis AND RTC pathology, a Reverse TSA will be considered.  Reverse TSA will permit accessory muscles to provide movement and restore function.

When will I start physical therapy after surgery?

  • This will depend on you surgeon’s protocol, but most people will start physical therapy within the first 1-2 weeks after surgery. You will likely be instructed to wear a sling for 4-6 weeks to allow healing, and so the early goals for physical therapy is to begin restoring flexibility of the shoulder, pain management, monitor the healing of the incision and start improving postural strength.

Will physical therapy hurt?

  • The reality is, after a surgery like you had, there will be discomfort and pain, but the goal is not to make the pain intolerable. Many times, the pain you have after surgery will be different than before. I try to remind people that the post-surgical pain is temporary. The first 2-3 weeks are typically the hardest, but after, many people will start to improve.  If pain persists, don’t lose hope, we have a number modalities to try and get the pain under control.

How long will I be in physical therapy?

  • This will vary some on the individual, but typically people will be in physical therapy for these types of surgery 6-10 weeks. The first phase of physical therapy will be passive movements where the therapist will be stretching and trying to restore flexibility. After the MD clears you from the immobilizer, PT will begin introducing active movements.  This will often start with active-assist movements, meaning you will be able to move with the aid of an assistive device. We will also start to work with you to move you upper extremity without assistance.  The 3rd phase will be strengthening.  This will typically be near the end of the series and the goal is to restore function.

What kind of exercises will I be doing in physical therapy?

  • This will depend on what phase you are in. In the early (passive) stage, you will be doing relatively simple exercises such as pendulums, gripping exercises, shoulder squeezes, and maybe neck stretches. Once active-assist begins, you can expect raising your arm with a stick, wall walks, and table slides.  Active phase will consist of actively moving your arm against gravity.  Strengthening phase will be adding resistance.

Are there other things that I should know?

– 1. IPT clinicians are highly trained and taking the extra steps to provide the most up to date knowledge as well as skill to prepare for events.  We also work closely with local surgeons to stay up to date with protocols, techniques, and procedures.  TSA and reverse TSA can be a roller coaster ride, but we will be prepared to help you through the challenging times. 2.  No surgery is ever the same.  It is hard to every compare one person to the next, so each person is individualized.


Joe Keller, PT, DPT, COMT – Stellhorn Clinic

About Joe:

I became a PT because during high school I experienced a handful of sports injuries, I then started to develop an interest in physical therapy. Later this became a passion.  My favorite part of my job is developing a relationship between clinician and patient. I love seeing the progress from day one to discharge.  Fun fact about me is I really enjoy traveling with family and try to collect baseballs (like post cards) every place we go. I currently have around 50.