Reverse total shoulder - how much activity is appropriate?

A healthy, active patient in her early sixties had a cuff repair 19 years ago, which failed. Then 10 years ago had an attempt at a revision of her cuff repair. She presented with pseuoparalysis and these x-rays.

A reverse total shoulder arthroplasty was performed. Here is the post op AP x-ray.

Two months post surgery, the x-ray appearance was stable

 Six months after surgery, she increased her physical activity, including gym workouts. X-rays at that time are shown below, with no evidence of problem

Two and a half years after surgery, the shoulder felt fine, but there was evidence of bone resorption beneath the baseplate.

Four and a half years after surgery, the shoulder felt fine, but there was increase bone respiration beneath the baseplate

There was no evidence of a problem on the axillary view

At five years after surgery and after a vigorous gym workout she presented with pain over the back of her scapular spine and these x-rays.

The axillary view shows a crack in the spine of the scapula (C)

Comment: This case brings up the question of the degree to which activities should be limited after a reverse arthroplasty


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To see a YouTube of our technique for a reverse total shoulder arthroplasty, click on this link.

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To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.

Use the "Search" box to the right to find other topics of interest to you.

How you can support progress in shoulder surgery

You may be interested in some of our most visited web pages  arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

Rotator cuff tears - does activity relate to progression?

Shoulder activity level and progression of degenerative cuff disease

These authors examined the relationship of shoulder activity with the risks of tear progression and pain development in 346 subjects (mean age 62 yrs) with an asymptomatic degenerative rotator cuff tear followed for a median duration of 4.1 years.

As determined by sequential interpretation of annual ultrasound reports, tear enlargement was seen in 177 shoulders (51.2%) and pain developed in 161 shoulders (46.5%) over time. 

Tear progression was defined as tear enlargement or conversion to a more severe tear type (partial to full thickness tear or control to partial or full-thickness tear). Partial and full-thickness cuff tears were considered enlarged if the tear size increased 5 mm or greater in any dimension compared with baseline.

Of note is the fact that the median duration of study follow-up was almost twice as long for the shoulders with tears that enlarged (6.0 years; IQR, 3.1-8.9 years) compared with the shoulders with stable tears (3.1 years; IQR, 2.0-5.0 years; P < .001).

Shoulder activity level and occupational demand level were not predictive of tear enlargement. Interestingly, patients who developed shoulder pain were less active than patients who did not.

Tear enlargement and pain development in asymptomatic tears were more common with involvement of the dominant shoulder. 

Comment: This is an interesting report of a large natural history study. It seems to indicate that in patients with asymptomatic rotator cuff tendon failure, tear size can progress with time independent of the shoulder's activity level. Of note, the authors do not suggest that the risk of tear progression is an indication for cuff repair.

This is surely good news for those of us with unoperated supraspinatus tears who continue to be active (and who avoided what would have been a painful 6 months of post-repair down time)!

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The reader may also be interested in these posts:

Healing through joint replacement

Supporting progress in shoulder surgery

Consultation for those who live a distance away from Seattle.

Click here to see the new Shoulder Arthritis Book.

Click here to see the new Rotator Cuff Book

Information about shoulder exercises can be found at this link.

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'See from which cities our patients come.

Ten Modifiable Health Risk Factors Are Linked To More Than One-Fifth Of Employer-Employee Health Care Spending

Ten Modifiable Health Risk Factors Are Linked To More Than One-Fifth Of Employer-Employee Health Care Spending.

This is a most provocative article, pointing out dramatically that health care costs can be reduced by healthy behaviors. This study over 90,000 employees of seven organizations found that over 20% of the health care costs were related to factors that could be modified: depression, high blood sugar, high blood pressure, obesity, tobacco use, physical inactivity and high stress.

For all the right reasons, we need to encourage healthy behavior in each other.

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If you have suggestions for topics you'd like us to address in this blog, please send an email to shoulderarthritis@uw.edu.

Use the "Search the Blog" box to the right to find other topics of interest to you. 

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.

See the countries from which our readers come on this post.

The Ream and Run Essentials

Ream and Run

We developed the ream and run for individuals with arthritis who desire high levels of physical activity, including impact to the shoulder, without risking failure of the plastic glenoid component that is used in total shoulder joint replacement. A bit about the rational and technique is shown here, here and here. And some details of the technique are shown here and here. In addition, the Video Journal of Orthopaedics has produced a nice video, which can be seen here.

Here is the common apppearance of the shoulder one week after arthroplasty - swelling is not unusual, but it resolves over the weeks after the procedure.

While the details of the rehabilitation after the ream and run may be customized according to the specifics of an individual shoulder, the program usually includes the exercises shown here.

Below is a series videos provided by patients having this procedure.
Supine stretch
Pulley
One month
6 weeks
7 weeks
8 weeks
10 weeks
12 weeks

The recovery after a ream and run shoulder replacement can be documented by following the simple shoulder test scores as shown here.

For examples of activities patients have performed after a ream and run, see this post.

Some patients have generously provided a diary of their recovery after the ream and run, as shown in these links
Post A

Post B

Post C
and if you like drumming
Post D
or chopping wood
Post E
or raquetball
Post F
or kayaking
Post G
or badminton and weights
Post H
or getting 'Grandpa' back up on his slalom ski that had been put away for 7 years
Post I
or violin
Post J

or throwing batting practice

Post K
or passing, serving in tennis, and hand stands
Post L

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Consultation for those who live a distance away from Seattle.

Check out the Shoulder Arthritis Book - click here.

Click here to see the new Rotator Cuff Book

To see the topics covered in this Blog, click here

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.

See from which cities our patients come.

See the countries from which our readers come on this post.