Total shoulder arthroplasty is the recommended surgical procedure for glenohumeral arthritis once conservative management is exhausted. Rehabilitation protocol for total shoulder arthroplasty. Rehabilitation guidelines for shoulder arthroplasty and reverse ball and socket arthroplasty the anatomic configuration of the shoulder joint glenohumeral joint is often compared to that of a golf ball on a tee. Shoulder arthroplasty rehab northeast orthopedics and. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 1 june 2017 v1s. Rehabilitation after total shoulder arthroplasty activities and advice for in the hospital and while at home. These patients often have severe limitations in shoulder function secondary the joint derangement.
In fact, rsa has played a pivotal role in making shoulder arthroplasty the fastest growing implant technology. To protect, repair and maintain your range of motion, it is. Total shoulder arthroplasty, or tsa, is a procedure used to replace the diseased or damaged ball and socket joint of the shoulder with a prosthesis made of polyethylene and metal components. Patients, who have continued shoulder pain and loss of function in the. Shoulder arthroplasty protocol this rehabilitation protocol has been developed for the patient following a shoulder arthroplasty replacement procedure. Meticulous surgical technique and skilled, carefully supervised, progressive rehabilitation is essential to ensure that the range of motion can be maximized, whereas improved strength, functional goals, and pain relief are achieved. The principles of rehabilitation are similar irrespective of the type of shoulder arthroplasty used. Total shoulder arthroplasty rehabilitation protocol the total shoulder arthroplasty tsa procedure is performed to improve function, increase active range of motion and reduce pain of the shoulder. Because pain relief was the goal and results of function were usually poor, neer stated that arthroplasty for rotator cuff. General time frames are given for reference to the average. The intent of this protocol is to provide the physical therapist with a guidelinetreatment protocol for the postoperative rehabilitation management for a patient who has undergone a reverse total. Operating room regional anesthesia beach chair position space suits iv antibiotics 14. Always be sure to ice your shoulder after you complete your exercises.
Pull down with good arm to raise the injured shoulder. Total shoulder replacementtsa hemiarthroplastyhumeral head replacement hhr case type diagnosis. Total shoulder arthroplasty rehabilitation guideline. Total shoulder arthroplasty post op rehabilitation patient name. Aromaarom cervical spine, elbow, wrist, and hand 4. Postoperative rehabilitation instructions reverse total. Total shoulder arthroplasty rehabilitation protocol. Longterm activity restrictions after shoulder arthroplasty.
Total shoulder arthroplastyhemiarthroplasty brigham and womens hospital. Shoulder rehabilitation western orthopaedic clinic. Shoulder examination tests 15032020 diagnose your shoulder this is an interactive guide to help you find relevant patient information for your shoulder problem. Rehabilitation guidelines for standard reverse total. Appointments physical therapy 23 xweek rehabilitation goals promote soft tissue healingmaintain the integrity of the replaced joint restore arom of elbow, wrist, and hand precautions. Johns hopkins shoulder surgery arthroscopic acromioplasty. Glenohumeral joint replacement and postoperative rehabilitation, which is found in the physical therapy journal, volume 55, 1975, pages 850858.
Reverse total shoulder arthroplasty rtsa rehabilitation protocol. This is because the articular surface of the round. Sling immobilization for first 46 weeksout of sling to do home exercise program pendulums twice. The rc is either absent or minimally functional with the rtsa. Make sure to rest from all painful activities until swelling subsides. Maintain surgical motion early, but protect subscapularis repair by avoiding. Postoperative rehabilitation guidelines for total shoulder. Rehabilitation after total shoulder arthroplasty sciencedirect. Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. The surgeon, physical therapist and patient need to take this into consideration when establishing the postoperative treatment plan. Rehabilitation is designed to maximize these adaptations and provide functional recovery of mobility after shoulder arthroplasty.
Shoulder arthroplasty 9780323529402 us elsevier health. The following steps can help you have optimal recovery. No physical therapy initiated until 5 weeks postoperatively a sling is to be worn for 6 weeks, and should not be removed except for elbow rom exercises. Same exercise but rotate the arm outwards and inwards. Early goals are to reduce shoulder stiffness and pain.
Hold for 10 seconds and repeat x 4 for both directions. Rehabilitation protocol for total shoulder arthroplasty and. Total shoulder replacement postop physical therapy protocol. The primary objective of this study is to compare outcomes between formal clinic based physical therapy pt rehabilitation and surgeon directed home therapy ht after reverse total shoulder arthroplasty rsa as measured by pain, range of motion, single assessment numerical evaluation sane, and american shoulder and elbow surgery ases scores at 6 weeks, 3, 6, 12, and 24 months. Early post surgery rehab first 6 weeks after surgery. Total shoulder arthroplasty hemiarthroplasty protocol.
In the first two sections, the authors take the reader through the history and evolution of rsa, followed by stepbystep surgical techniques for specific injuries and conditions. The shoulder is a ball and socket joint that enables you to raise, twist, bend and move your arms forward, to the sides and behind you. Physician incision approach is important in rtsa rehab. Rehabilitation after shoulder arthroplasty clinical gate. This procedure replaces your damaged hip joint with an artificial hip implant. Reverse total shoulder arthroplasty rtsa is designed for the treatment of glenohumeral gh arthritis when it is associated with irreparable rotator cuff tears,complex fractures, severe glenoid deformity from dysplasia or wear, or for a revision of a previously failed conventional total shoulder arthroplasty tsa. Higher numbers of repetitions 15 20 favor increased muscle endurance while. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation. The intent of this protocol is to provide the physical or occupational therapist with a guideline and treatment protocol for the postoperative rehabilitation management for a patient who has undergone a reverse total shoulder replacement rtsr. This is the information which might be shared with patients after a shoulder arthroplasty.
Phase i immediate post surgical phase meets criteria for progression to phase ii. Anatomical and biomechanical framework for shoulder arthroplasty rehabilitation. The anatomic configuration of the shoulder joint glenohumeral joint is often compared to that of a golf ball on a tee. Total shoulder arthroplasty rehabilitation guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. Rehabilitation following total shoulder arthroplasty reg b. Rehabilitation after total shoulder arthroplasty dr. Paff the intent of this protocol is to provide the clinician with guidelines of the postoperative rehabilitation of someone undergoing total shoulder arthroplasty or hemiarthroplasty. Each case can be very different depending on the goals of the patient, the age of the. These rehabilitation guidelines are presented in a criterion based progression.
The plasticity of collagen allows connective tissues to adapt to physiologic and pathologic conditions. This protocol is intended to guide clinicians and patients through the post operative course after a total shoulder arthroplasty tsa and hemiarthroplasty. Shoulder replacement rehabilitation program johns hopkins. Minimize heavy, excessive cyclic loads for the first 6 months. Rehabilitation following total shoulder arthroplasty. Total shoulder arthroplasty protocol boston shoulder institute. The intent of this protocol is to provide the therapist with a guideline for the postoperative rehabilitation course of a patient that has undergone a total shoulder arthroplasty tsa or hemiarthroplasty humeral. Pdf rehabilitation following reverse shoulder arthroplasty. Before it can be applied to a specific clinical situation however it needs to be tailored to the patient the surgery and the surgeon. Learn more about shoulder replacement rehabilitation following shoulder replacement surgery here. Magnussen ra, mallon wj, willems wj, moorman ct 3rd. Total shoulder arthroplasty rehabilitation protocol your shoulder rehabilitation program begins while you are in the hospital. Rotator cuff and shoulder conditioning program introduction 1 additional notes.
Shoulder arthroplasty and its effect on strain in the subscapularis muscle. Mathes about shoulder replacement surgery shoulder replacement surgery is a major operation. But more than 50,000 shoulder replacements are done in the u. Apply ice, or the cooling unit, to the shoulder as it will be quite helpful. Physical therapy for reverse total shoulder replacement. It is designed for rehabilitation following total shoulder arthroplasty. Reverse total shoulder arthroplasty rtsa is designed specifically for the treatment of glenohumeral shoulder arthritis when it is associated with irreparable rotator cuff damage, complex fractures as well as for a revision of a previously failed conventional total shoulder arthroplasty. Reverse total shoulder arthroplasty 2012 center for sports. Department of rehabilitation services reverse total. Total shoulder arthroplasty rehabilitation request pdf. Request pdf total shoulder arthroplasty rehabilitation total shoulder arthroplasty is the recommended surgical procedure for glenohumeral arthritis. Modern implants provide a wide range of options, including resurfacing of the humeral head, anatomic hemiarthroplasty, total shoulder arthroplasty, reverse shoulder arthroplasty and traumaspecific implants for fractures and nonunions.
Reduce pain, inflammation and muscular inhibition, increase prom of shoulder, allow healing of soft tissue. Sling worn continuously for 34 weeks, no shoulder arom, no lifting of objects. Sling only to be worn while sleeping, no lifting of objects heavier than a coffee cup, no sudden movements, pillow to be placed under elbow when in supine. This is summary of the evaluation and rehabilitation of a patient following an arthroscopic acromioplasty.
It is by no means intended to be a substitute for a physical. Total hip arthroplasty tha is an elective operative procedure to treat an arthritic hip. The most effective strength training and rehabilitation programs include at least one set of the maximum number of repetitions possible for each exercise performed exercise to fatigue. Periscapular submax pain free isometrics in scapular plane 5. Millett, md, msc3 total shoulder arthroplasty tsa is a standard operative treatment for a variety of disorders of the. Total shoulder arthroplastyhemiarthroplasty protocol. Physical therapy rehabilitation following total shoulder replacement using total motion release techniques in combination with traditional intervention volume 2 issue 3 2018 ennifj er adame walker assistant professor, department of physical therapy, california state university fresno, usa correspondence. Thap total hip arthroplasty protocol, thapcp total hip arthroplasty physiotherapy care protocol. This protocol will vary in length and aggressiveness depending on factors such as. Rehabilitation guidelines following total ankle arthroplasty rehabilitation is vital to regaining motion, strength and function of the ankle after surgery. This procedure is specifically designed for the treatment of glenohumeral gh joint.
Important rehabilitation management concepts to consider for a postoperative physical therapy. Physical therapy rehabilitation following total shoulder. The primary goals of early rehabilitation are to promote soft tissue healing and preserve glenohumeral mobility. Mar 16, 2011 shoulder arthroplasty has been the subject of marked advances over the last few years. Gallandkirby total shoulder arthroplasty postsurgical rehabilitation protocol postop days 1 14 sling for comfort, dc after 45 days sleep with pillow under shoulder arm for comfort hand squeezing exercises elbow and wrist active motion arom pendulum exercises.
Reverse total shoulder replacement postoperative rehabilitation this protocol was developed for patients who have undergone a reverse total shoulder replacement. Physical therapy for reverse total shoulder replacement this handout has information about your reverse total shoulder replacement and the exercises you will need to do after your surgery. Omearas total shoulder arthroplasty rehabilitation protocol. Reverse total shoulder replacement rehabilitation guidelines. Rehabilitation following reverse total shoulder arthroplasty. Hip implants consist of 1 a smooth ball on a stem that fits into your thigh bone the femoral stem, and 2 a. The shoulder is a complex structure that has five articulations, i. Shoulder arthroplasty rehabilitation protocol general information shoulder replacement for arthropathy is an operation for pain relief. We use a hydrotherapybased rehabilitation regimen after shoulder arthroplasty to regain shoulder mobility. Maintenance of good postural positioning when performing all exercises. Reverse or inverse total shoulder arthroplasty rtsa is becoming a widely accepted surgical intervention. The postoperative course emphasizes early range of motion and gradual progression of strength and restoration of function.
Rehabilitation guidelines for shoulder arthroplasty and reverse. Begin flexion, ir, er, and elevation in scapular plane, submaximal painfree shoulder isometrics in neutral, progress scapular and distal extremity strengthening. Department of rehabilitation services reverse total shoulder. Treatment should be modified based on the condition of the rotator cuff. Specific interventions should be based on the needs of the individual and. Randomized trial were instructed to continue to perform the physiotherapy exercises at home after hospital discharge and. American shoulder and elbow surgeons standardized shoulder. Shoulder replacement surgery replaces damaged joint surfaces with artificial. Additionally, as the biomechanics of this prosthesis are markedly different, there. Rehabilitation protocol for reverse shoulder arthroplasty. Phase i immediate post surgical phase meets criteria for progression to. Physical therapy constitutes an essential determinant of clinical outcome after total shoulder arthroplasty. Significant gains in function during rehabilitation may be achievable following joint arthroplasty. Over the years, shoulder joint replacement has come to be used for many other painful conditions of the shoulder, such as different forms of arthritis.
Home exercise vs pt for reverse total shoulder arthroplasty. Reverse total shoulder replacement is performed for a variety of indications. The head of the upper arm bone humerus is the ball and a circular depression glenoid in the shoulder bone scapula is the socket. Rehabilitation guidelines for shoulder arthroplasty and. Presence of a functional rotator cuff intact or repaired type of shoulder replacement anatomic or. Journal of orthopaedic and sports physical therapy. Therefore, the rehabilitation for a patient following rtsa is different than the rehabilitation following a traditional tsa.
An open surgery, which involves the deltoid, should be protected with prom for a least 3 weeks. Millett, md, msc3 total shoulder arthroplasty tsa is a standard operative treatment for a variety of disorders of the glenohumeral joint. Rehabilitation following reverse shoulder arthroplasty article pdf available in obere extremitat april 2019 with 351 reads how we measure reads. Total shoulder arthroplasty rehab protocol physical therapy haven.
The following is a guideline for progression of postoperative treatment general information time required for full recovery is 912 months. The first reported total shoulder arthroplasty was reported by a french surgeon named jules emile pean in 1893 for the purpose of treating tuberculous arthritis of the shoulder. Boudreau s1, boudreau ed, higgins ld, wilcox rb 3rd. Reverse total shoulder arthroplasty the reverse, or inverse, total shoulder arthroplasty rtsa. Shoulder replacement surgery is less common than hip or knee replacements.
Shoulder rehabilitation treatment includes activity modification, stretching, and strengthening the affected limb. Postoperative rehabilitation guidelines for total shoulder arthroplasty tsa the intent of this protocol is to provide the physical therapist with a guidelinetreatment protocol for the postoperative rehabilitation management for patients who have undergone a total shoulder arthroplasty. Postoperative rehabilitation instructions reverse total shoulder arthroplasty application of the abduction sling. Reverse total shoulder replacement therapy protocol. Focusing on all key aspects of shoulder replacement surgery and emphasizing the latest techniques and tools, shoulder arthroplasty, 2nd edition, brings you expert procedural approaches from two master surgeons in the field.
Rehabilitation guidelines following total ankle arthroplasty. It is not intended to be a substitute for special instructions from. Rehabilitation protocol for total shoulder arthroplasty and hemiarthroplasty this protocol is intended to guide clinicians and patients through the postoperative course after a total shoulder arthroplasty tsa and hemiarthroplasty. Pdf rehabilitation following reverse total shoulder.
The most common indications are rotator cuff tear arthropathy. The intent of this protocol is to provide the physical therapist with a guidelinetreatment protocol for the postoperative rehabilitation management for a patient who has undergone a reverse total shoulder arthroplasty rtsa. In tsa, the current components of the glenoid are either a pegged or keeled highmolecular weight polyethylene cemented component. Treatment algorithm for progressing the rehabilitation program for a patient that has had a total shoulder arthroplasty. This is because the articular surface of the round humeral head is approximately four times greater than. Use of a sling for 3 weeks postop unless otherwise indicated. Variances will be communicated by the surgeon directly to rehabilitation services. Rehabilitation of shoulder arthroplasty springerlink.
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