Rehabilitation Following Total Shoulder Arthroplasty

Abstract

Total shoulder arthroplasty (TSA) is a standard operative treatment for a variety of disorders of the glenohumeral joint. Patients, who have continued shoulder pain and loss of function in the presence of advanced joint pathology, despite conservative management, are often managed by undergoing a TSA. The overall outcomes that are reported after surgical intervention are quite good and appear to be primarily determined by the underlying pathology and the tissue quality of the rotator cuff. The current Neer protocol for postoperative TSA rehabilitation is widely used and based on tradition and the basic science of soft tissue and bone healing. The purpose of this paper is to review the indications for TSA, focusing on the underlying pathologies, and to describe the variables that impact the rehabilitation program of individuals who have had a TSA. A postoperative TSA rehabilitation protocol and algorithm, founded on basic science principles and tailored toward the specific clinical condition, are presented. J Orthop Sports Phys Ther 2005;35:821-836. Key Words: physical therapy, protocols, shoulder rehabilitation T he first total shoulder arthroplasty (TSA) was performed by Jules Emile Pean in 1893 for the purpose of treating tuberculous arthritis of the shoulder. 68 Neer 81 developed a humeral prosthesis for the treatment of 4-part fractures in 1955, and in the mid-1970s he refined his prosthesis for the treatment of the degenerative humeral head. 82 TSA is a standard treatment intervention for patients with underlying advanced joint pathology who have persistent pain and loss of function despite conservative management. These pathologies include osteoarthritis (OA), 7,13,30,32,39,41,43,44,64,71,74,82,86,88,89,100,101 rheumatoid arthritis (RA), 6,34,35,38,52,61,64,76,91,102,106 cuff tear arthropathy, 5,33,64,94,95,107,111 osteonecrosis, 26,48,49,64,70,79 and fractures of the humeral head. 2,3,6,21,42,62,69,85,90,93 Over the last 25 years, surgical techniques and prostheses have advanced greatly. However, there is still considerable variability in surgical techniques, particularly the use of cement for fixation and the type of prosthesis. Despite these significant variations, the overall reported outcomes for patients that have undergone TSA are good. 31,49,64,99,104 Self-assessed health status reports of individuals who have undergone TSA are comparable to those of individuals who have undergone a total hip arthroplasty or coronary artery bypass graft.

The Simple Shoulder Test Is Responsive in Assessing Change Following Shoulder Arthroplasty

“…Following SA, strengthening exercises are usually started 6 to 12 weeks postoperatively with gentle isometric strengthening. 4,35 Thereafter, 12 weeks postoperatively, they are progressed gradually to isotonic strengthening. 4,35 Therefore, at 6 months, is the limited number of subjects evaluated for their ROM and isometric strength.…”

“…4,35 Thereafter, 12 weeks postoperatively, they are progressed gradually to isotonic strengthening. 4,35 Therefore, at 6 months, is the limited number of subjects evaluated for their ROM and isometric strength. The 2 primary reasons why these measures were not obtained on all patients were that (1) patients were unable or had too much pain to complete strength and ROM testing prior to surgery and (2) a minority of patients became fatigued during hospital visits and chose to only complete the self-report questionnaires.…”

“…35 Measures of physical impairment and selfreported function are commonly used to assess the outcomes of these procedures. Various self-reporting scales are available to measure the functional outcome of shoulder surgery, but only a few While the responsiveness of the SST has been established for rotator cuff repair, it has not been determined for patients undergoing arthroplasty.…”

Management of Shoulder Hemiarthroplasty in a Patient With Rheumatoid Arthritis

“…4,13,36,44 Many studies show that connective tissue consistently responds better to early controlled mobility than immobility. 1,14,27,39,40 However, early mobility after shoulder hemiarthroplasty must be balanced against the risks of tissue damage, increased pain, and instability.…”

Shoulder joint replacement in rheumatoid arthritis – surgical treatment and physiotherapy

“…Polega ona na prawidłowym ułożeniu koń-czyny operowanej w lekkim odwiedzeniu (ok. 60°) i rotacji zewnętrznej (15°) [9]. Zalecana jest również krioterapia oraz ćwiczenia przeciwobrzękowe kończyny górnej tuż po ustąpieniu znieczulenia operacyjnego (ryc.…”