Saturday, August 22, 2015

Total shoulder - how much motion will the patient have?

Factors predicting postoperative range of motion for anatomic total shoulder arthroplasty

These authors presented 1 year minimum followup on 230 patients having total shoulder for end-stage arthropathy with an intact rotator cuff. While patients with diabetes and obesity had less internal rotation, the strongest predictor of postoperative range of motion was the preoperative range.

Comment: The question prompted by this study is whether preoperative therapy to increase the range of motion before surgery might improve the postoperative result.

This is a useful paper from a number of standpoints. First of all the active range of motion was actually measured with a consistent goniometric method (rather than 'eyeballed', which is so often the case). Secondly, the authors clarified that the motions measured were humerothoracic, not glenohumeral. Thirdly, the results enable surgeons to inform their patients that stiffness before surgery predisposes them to less range of motion afterwards, but the 'rule of thumb' of an average improvement in flexion of 45 is useful. Fourth, they present a method for patient self-assessment of range of motion, asking the patient to grade their shoulder. We suggest that rather than asking the patient to send in the grade, they could send in photo of the shoulder attempting each of these motions.


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