Rehabilitation of a Patient Status Post Reverse Total Shoulder Replacement

Abstract

PURPOSE: This case study discusses a 71 year old male subject who underwent a Reverse Total Shoulder Replacement (RTSR), a fairly new surgical procedure performed to address shoulder dysfunction. This procedure involves utilizing a concave prosthetic component on the humerus and a convex component on the scapula instead of the convex humeral and concave scapular components typically used in conventional shoulder joint replacements. Since the procedure is just now beginning to be performed in the United States, it is important to make health professionals aware of the technique, why it is utilized, and what outcomes may be expected. METHODS: The subject of this case study was five days post surgery upon initial physical therapy evaluation. Only passive range of motion (ROM) was allowed for the first month of treatment, within the following ranges: external rotation (ER) to 25° in neutral, ER to 60° at 90° of abduction, and internal rotation of hand to hip only. More aggressive treatment including active assisted ROM and active ROM was initiated after one month along with light strengthening including shoulder isometrics and scapular stability exercises. Therapy progressed to more aggressive strengthening of the entire upper extremity and scapular region, and also included Russian electrical stimulation to the deltoid for neuromuscular re-education. RESULTS: After fifty therapy sessions, passive shoulder ROM had noticeably increased for all shoulder motions. Active ROM of shoulder flexion improved from 90° to 150° and abduction increased from 80° to 130°. Active ER ROM only minimally improved; from neutral to 60°. The subject was able to return to most activities of daily living, and was able to functionally swing a golf club without increased pain. CONCLUSIONS: Results seen with this subject do not necessarily compare favorably to a standard shoulder joint replacement. The subject required a lengthy course of rehabilitation and had residual limitations in ROM and muscle strength. These deficits, however, could be due to the subject's significantly deteriorated deltoid and rotator cuff strength that was present prior to the surgery. Because RTSR surgery may become more prevalent in the future, therapists need to be aware of this new procedure and incorporate therapeutic interventions that may lead to positive outcomes.