Monday, June 17, 2013

Shoulder function before and after arthroplasty

Isometric strength, range of motion, and impairment before and after total and reverse shoulder arthroplasty

This article assesses objective measures of impairment before and after shoulder arthroplasty using Biodex isometric strength and standardized video range of motion measurements performed by an independent third-party observer at 1 week before surgery and at an average of 4 years after surgery. Impairment ratings were calculated using the Florida Impairment Guidelines. 

Patients having revision arthroplasty had the greatest preoperative impairment (28%) and improved to 20%.
Patients having primary reverse total shoulder had a preoperative impairment of 25% and improved to 15%
Patients having primary anatomic total shoulder had a preoperative impairment of 21% and improved to 10%

The Florida Impairment Guidelines was selected by the authors because of its "distinct and purposeful omission of any scoring component for pain. " This places the assessments used in this study in marked contrast to patient reported outcome measures such as the Simple Shoulder Test or the ASES score. Whether "objective" is more meaningful than "subjective" or vice versa may depend on the audience. Patients may be more interested in learning of the effectiveness of a procedure in improving the self-reproted comfort and function of the shoulder. 

It is important to recognize that while these procedures were effective on average in lessening the disability rating, the treated shoulders did have residual disability. Patients need to be informed that we do not make their shoulders 'normal' with our surgical reconstruction.

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