The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation for anatomic total shoulder arthroplasty

Abstract

Anatomic total shoulder arthroplasty is the gold standard shoulder replacement procedure for patients with an intact rotator cuff and sufficient glenoid bone to accommodate prosthetic glenoid implant and offers reliable patient satisfaction, excellent implant longevity, and a low incidence of complications. Disparity exists in the literature regarding rehabilitation strategies following anatomic total shoulder arthroplasty. This article presents a consensus statement from experts in the field on rehabilitation following anatomic total shoulder arthroplasty. The goal of this consensus statement is to provide a current evidence-based foundation to inform the rehabilitation process after anatomic total shoulder arthroplasty. These guidelines apply to anatomic total shoulder arthroplasty (replacement of the humeral head and glenoid), hemiarthroplasty (replacing only the humeral head), and hemiarthroplasty with glenoid reaming or resurfacing. The consensus statement integrates an extensive literature review, as well as survey results of the practice patterns of members of the American Society of Shoulder and Elbow Therapists and the American Shoulder and Elbow Surgeons. Three stages of recovery are proposed, which initially protect and then gradually load soft tissue affected by the surgical procedure, such as the subscapularis, for optimal patient outcomes. The proposed guidelines should be used in collaboration with surgeon preferences and patient-specific factors.

Effect of Exercise Intensity on the Healing of the Bone-Tendon Interface: A Mouse Rotator Cuff Injury Model Study

“…Postoperative rehabilitation is important to achieve high-level functional performance. 21 The present study highlights the importance of appropriate mechanical stimulation for BTI healing after surgery.…”

Rehabilitation following shoulder arthroplasty: a survey of current clinical practice patterns of Italian physiotherapists

“…Moreover, patient education strategies are considered as important in order to guarantee a good functional recovery. Regarding another fundamental aspect of clinical practice, Italian PTs are more keen to apply non self-reported outcome measures (e.g., ROM and strength assessment), compared to self-reported outcome measures (e.g., Disability of the Arm, Shoulder and Hand (DASH) Questionnaire), although the use of the latter is highly recommended by the literature [ 46 , 47 ].…”

Rate of improvement in shoulder strength after anatomic and reverse total shoulder arthroplasty

“…Later FE strength recovery may also be explained by greater limitations on rehabilitation in the immediate weeks after aTSA in an effort to protect the subscapularis repair. 5 , 10 Furthermore, the reliance on a healing subscapularis for shoulder stability after aTSA may result in pain that limits strength, whereas stability in rTSA is dependent on the deltoid. 10 , 11 , 12 , 18 These differences in the biomechanics, postoperative rehabilitation, and stability likely also explain the early loss of both ER and FE strength between baseline and 3 months after aTSA but not after rTSA ( Figure 1 , Figure 2 ).…”