Publicly available online activity restrictions after reverse total shoulder arthroplasty demonstrate marked...

Physicians may implement post-operative restrictions following reverse total shoulder arthroplasty (rTSA) due to concerns of post-operative instability and accelerated polyethylene wear. However, no data support the amount of weight patients should limit above and below horizontal. The current study analyzes available online provider, group practice, and hospital protocols pertaining to restrictions following rTSA. The authors hypothesize that protocols will have substantial variability in both rehab milestones and lifetime lifting limits.

The search query "reverse total shoulder arthroplasty weight restrictions" was entered on January 25, 2026. The first 50 websites that met inclusion criteria were included. Websites were evaluated for presence of lifetime weight restrictions, weight restriction above and below horizontal, duration of immobilization, timing of physical therapy, timing of range of motion (ROM), timing of strengthening exercises, timing of return-to-sport (RTS), and incorporation of scientific references.

Website categories were 23 (46%) single provider, 15 (30%) group practice, and 12 (24%) hospital-based. Mean post-operative immobilization was 4.7 ± 1.4 weeks (2 to 8 weeks), with 79.1% recommending ≥4 weeks of immobilization. Shoulder passive ROM was initiated at 0.9 ± 1.2 weeks, active-assisted ROM at 4.2 ± 1.9 weeks, and active ROM at 5.8 ± 1.9 weeks. Five (10%) websites specified no lifetime weight restrictions, 20 (40%) implemented lifetime restrictions, and 25 (50%) did not specify. Maximum weight below horizontal was 11.8 ± 4.1 kgs (26.0 ± 9.1 lbs) and above horizontal was 9.3 ± 4.0 kgs (20.4 ± 8.9 lbs). Twenty-three (46%) websites mentioned RTSs. Fifteen of these websites (68.2%) reported RTSs at 3.6 ± 0.6 months. Twelve websites (24%) mentioned golf, 10 (20%) racquet sports, and 7 (14%) swimming.

Online protocols are highly variable with respect to lifetime weight restrictions, post-operative rehabilitation, and RTS expectations following rTSA. Despite no formal recommendations in the literature regarding lifetime weight restrictions, 40% of websites specified weight restrictions below and above horizontal. Future studies should elucidate safe weight limit thresholds and specific therapy protocols to guide formal recommendations.