Physiotherapy after shoulder surgery,
the operation is only the first step

Very much so. Replacing the joint or repairing the rotator cuff is only one step of the operation. If activity is not restored in stages after surgery, the tissue around the joint sticks and the muscles waste, and the arm may still not lift even with a new joint. The aim of rehabilitation is to balance protecting the repair or implant with avoiding stiffness. This needs professional guidance in stages, with neither unguided movement nor no movement at all.

A randomised controlled trial (RCT) has compared them directly: after reverse total shoulder arthroplasty (rTSA), home physiotherapy gave results similar to formal outpatient physiotherapy (Schick et al., JSES 2023). For older adults with one arm in a sling, going out is already difficult, and a home visit saves the travel and an escort, and the therapist can teach safe use of the arm in the real home setting. A home visit is not a second-best choice.

The stability of a reverse replacement depends on the deltoid, a mechanism different from an ordinary (anatomic) replacement, and the movements to avoid are the opposite. In the first stage after surgery, the combination of reaching the arm backwards, close to the body, with inward rotation should generally be avoided, for example tucking in a shirt, cleaning after using the toilet, or reaching behind the back to undo a bra. These movements are the most likely to cause a dislocation. The exact period of restriction and what is allowed must be set by the surgeon and physiotherapist according to the operation, and cannot be generalised.

No. The sling protects the repair or implant, but too much immobilisation raises the risk of joint stiffness. In clinical practice 4 to 6 weeks is the usual reference (longer for large tears or particular operations), with passive or assisted movement beginning in stages during this time. Wearing it until it stops hurting is a common misunderstanding. When to take it off and how to loosen up step by step should follow the staged instructions of the surgeon and therapist.

Both age and tear size affect healing. Research shows that the one-year healing rate after surgery is about 66% for small tears, about 68% for medium tears, about 47% for large tears and only about 27% for massive tears, and that age is a more dominant independent risk factor than tear size (Rashid et al., Acta Orthop 2017). This does not mean surgery is not worthwhile, and many older adults still improve in function afterwards. It does mean setting realistic expectations and making the most of the situation through rehabilitation after surgery.

Success in rehabilitation depends on following the stages and avoiding stiffness, and the key window for rehabilitation often coincides with the waiting period for public hospital physiotherapy. With a home visit the therapist can teach safe movements on the spot at home, adapt the home environment (bed height, grab rails, toilet seat), guide carers in correct support and in putting the sling on and taking it off, and take over straight away in the gap after discharge. HK$1,000 for 1 hour and HK$1,300 for 1.5 hours, with no minimum spend, and a registered physiotherapist visits in person.