Wednesday, April 5, 2023

Reverse total shoulder arthroplasty - post operative therapy, outcomes, satisfaction and complications.

While "hands on" physical therapy can be helpful in many situations, it can also be time consuming, and expensive. Occasionally patients are pushed a bit too hard, resulting in increased discomfort or even injury.

The authors of Active physical therapy does not improve outcomes after reverse total shoulder arthroplasty: a multi-center, randomized clinical trial compared the range of motion (ROM) and patient-reported outcomes (PROs) between a structured home exercise program (HEP) consisting of a handout and a rope pulley and prescribed supervised physiotherapy (PT) after primary reverse total shoulder arthroplasty (RSA) in a randomized clinical trial.

They attribute the home exercise program to Sarah Jackins, founding member of the American Society of Shoulder and Elbow Therapists (see this link).





All patients within this study received Grammont-style implants and did not undergo repair of the subscapularis. 89 patients were randomized, 43 to PT, and 46 to HEP. The authors obtained 1-year patient reported follow-up on 83 patients (93%) and ROM follow-up on 73 patients (82%). Nine patients (20%) crossed over from HEP to PT and 2 patients (4%) crossed over from PT to HEP.

It is of interest to see that the comfort and function of patients with RSA increased progressively over the first year after surgery.




Complications after reverse total shoulder occurred in one out of seven patients. (13% of HEP and 17% of PT patients).

Within the HEP group, the following complications occurred: 1 intraoperative humeral fracture, 1 case of postoperative ulnar neuritis, 1 postoperative fall that resulted in a brachial plexitis, 2 patients with instability, and 1 infection.

Within the PT group, the following complications occurred: 1 axillary nerve palsy, 1 case of postoperative carpal tunnel syndrome, 1 patient with instability, and 1 patient with stiffness.

Both groups had limitations in rotation, with the mean internal rotation being to the waist; only 48% (34/71) of patients experienced improvement in internal rotation with RSA.

12% (72/82) of patients described some symptoms of instability within 1-year postoperatively.

The satisfaction rate was 90% (74/82), but only 76% (62/82) stated that they would have the surgery again.

The authors concluded that "in this 2-center, randomized clinical trial, there were no significant differences in patient outcomes between HEP and PT after RSA. These findings suggest that it may not be necessary to recommend PT as a protocol for all patients after RSA".

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).