Abstract
PurposeThe purpose of this review is to describe the role of altered joint biomechanics in reverse shoulder arthroplasty and to propose a rehabilitation protocol for a cuff-deficient glenohumeral joint based on the current evidence.Methods and Materials: The proposed rehabilitation incorporates the principles of pertinent muscle loading while considering risk factors and surgical complications.ResultsIn light of altered function of shoulder muscles in reverse arthroplasty, scapular plane abduction should be more often utilized as it better activates deltoid, teres minor, upper trapezius, and serratus anterior. Given the absence of supraspinatus and infraspinatus and reduction of external rotation moment arm of the deltoid in reverse arthroplasty, significant recovery of external rotation may not occur, although an intact teres minor may assist external rotation in the elevated position.ConclusionImproving the efficiency of deltoid function before and after reverse shoulder arthroplasty is a key factor in the rehabilitation of the cuff deficient shoulders. Performing exercises in scapular plane and higher abduction angles activates deltoid and other important muscles more efficiently and optimizes surgical outcomes.
Highlights
The first shoulder replacement was performed for tuberculous arthritis by a French orthopedic surgeon, Jules E
Grammont understood the importance of the balance between the supraspinatus-deltoid couple force and the role of the prosthesis’s centre of rotation (COR) in the cuff-deficient joint
The use of reverse total shoulder arthroplasty (RTSA) was approved in the United States by the Food and Drug Administration (FDA) in November 2003 and over the past two decades its indications which were initially limited to cuff tear arthropathy (CTA) have increased to include massive irreparable rotator cuff tears in the absence of osteoarthritis, proximal humerus fractures, glenohumeral osteoarthritis with excessive posterior glenoid erosion and revisions for failed anatomical arthroplasty.[5,6,7,8,9,10,11]
Summary
The first shoulder replacement was performed for tuberculous arthritis by a French orthopedic surgeon, Jules E.
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