Will I be able to return to work after my shoulder surgery?

Return to Work Following Shoulder Surgery

These authors assessed the postoperative return to work (RTW) for a large series of patients having shoulder surgery by an individual surgeon. 

Six months following the shoulder operations, 77% of the patients returned to work (40% with full duties and 37% with light duties). 

Concomitant rotator cuff repair and stabilization was associated with the highest RTW rate (90%) whereas some of the lowest RTW rates were associated with reverse total shoulder arthroplasty (56%) and total shoulder arthroplasty (71%). 

The highest rate of RTW with full duties was associated with debridement for calcific tendinitis (62%). 

Capsular release was the only procedure to result in a significant improvement in work level within 6 months, providing a significant improvement in work level from preoperatively to postoperatively (p = 0.0116). 

Older patients with stiffer shoulders who were not working preoperatively had the lowest RTW rate at 6 months.

The most significant factors were assessed using a multiple logistic regression analysis in order to identify independent factors that best predict whether patients will RTW at 6 months postoperatively. The best independent predictors of RTW were younger age, less stiffness, and working preoperatively.

Comment: This study of the practice of an individual surgeon demonstrates that return to work is likely to be a different metric than patient reported outcome measures (PROMs). It would have been interesting to see the relation between the two, in other words, how did improvement in PROM relate to RTW?  

It is surely humbling to see that only one of the procedures studied was successful in improving the mean work level at 6 months after surgery. If improving the ability to perform work is the primary objective of the surgery, a candid discussion of likelihood and predictors of success would seem warranted. 

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Ream and run or total shoulder arthroplasty?

Comparative analysis of work-related outcomes in hemiarthroplasty with concentric glenoid reaming and total shoulder arthroplasty

These authors conducted a retrospective study of patients having a ream and run procedure (RnR) between 2005 and 2014 and matched them to an anatomic total shoulder (TSA) cohort by age, body mass index, sex, and hand dominance.

Patients undergoing aTSA were counseled that they should expect overhead lifting restrictions of 10 pounds (4.5 kg), whereas those undergoing RnR did not have these restrictions.

They assessed preoperative and postoperative level of duty and occupation. Twenty-five RnR patients and 28 TSA patiets completed the questionnaire (82.8% compliance). Mean follow-up was 69.1 ± 24.8 months.  100% of the RnR patients returned to work, while 89.3% of TSA patients returned to work (P = .091). RnR patients had higher rates of return to work for heavy-duty workers only (7 of 7 vs. 2 of 4, P = .038). Mean duration of return to work was 2.5 ± 4.8 months for patients receiving RnR and 1.98 ± 2.6 months for those receiving TSA (P = .653).

The authors concluded that patients having the ream and run arthroplasty had a high return to heavy-duty work due to fewer surgeon-imposed restrictions. 

Comment: In a study just completed, we found that in our practice the outcomes of patients having the ream and run (RnR) and those having total shoulder arthroplasty (TSA) were essentially the same, but the patients having the two procedures were different. 

We identified 544 patients who had either a total shoulder or a ream and run arthroplasty performed between 8/24/2010 and 8/9/2016. 

Two year clinical outcomes were available on 263 (89%) of the 295 ream and run procedures and 281 (82%) of the 343 total shoulders enrolled during this study period. 

Patients electing RnR were more likely to be male (92.0% vs. 47.0%), younger (mean±SD 58±9 years vs. 67±10 years), married (83.2% vs. 66.8%), from out of state (51.7% vs. 21.7%), commercially insured (59.1% vs. 25.2%), and had better SF36 scores (p<.001).  

Shoulders having RnR in comparison to those having TSA were more likely to have type B2 glenoid pathoanatomy (46.0% vs. 27.8%) and greater glenoid retroversion (mean±SD 19±11 vs. 15±11 degrees). 

The mean±SD final Simple Shoulder Test score for the RnR procedures was 10.0±2.6 vs. 9.5±2.7 for the TSAs. The percent of maximum possible improvement averaged 72±39 for the RnRs and 73±29 for the TSAs. Patients with work related shoulder problems had lower final SST scores (difference -2.3, 95% CI -3.5 to -1.1, p<.001) and lower %MPI (difference –25, 95% CI –39 to -12, p<.001).  While age did not have an effect on RnR outcomes, younger patients tended to do less well after TSA. 

Our investigation highlights the importance of patient selection in considering the surgical procedure for glenohumeral arthritis. Studies of shoulder arthroplasty outcome should characterize the patient and the shoulder using the important variables identified in our study.

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Return to work after humeral hemiarthroplasty and reverse total shoulder arthroplasty

A comparative analysis of work-related outcomes after humeral hemiarthroplasty and reverse total shoulder arthroplasty

These authors conducted a review of patients who underwent a reverse total shoulder (RTSA, N = 40) or  or humeral hemiarthroplasty.

Inclusion criteria were a preoperative diagnosis of endstage glenohumeral arthritis with rotator cuff dysfunction, deficiencies in glenoid bone stock that prohibited the insertion of an anatomic glenoid component, proximal humerus fracture, and minimum of 1-year follow-up. The study included patients who underwent revision or bilateral procedures. The study excluded patients with other preoperative diagnoses, patients with <1-year follow-up, and patients who had not worked within 3 years preoperatively. 

 Postoperatively, 65% of RTSA patients returned to work compared with 70.7% of HHA patients (P = .64). 

Comment: The choice of type of arthroplasty among the wide range of diagnoses and patients in this series was highly individualized by the surgeon and the patient. The two groups are not likely to be comparable without controlling for the many variables that affect the result.

However, what is of interest in this paper is the surgeons' success in achieving a high percentage of patients that were able to return to work after their surgery - especially considering the average age of the patients. Individuals are working later in their lives and those considering shoulder surgery are interested in knowing whether a return to work is likely. This study provides relevant information for each of these two procedures.

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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'

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Getting back to work after a cuff repair

Prospective evaluation of clinical and radiologic factors predicting return to activity within 6 months after arthroscopic rotator cuff repair

These authors evaluated 365 patients having arthroscopic cuff repair. 305 were able to return to work or spare-time activities by 6 months after surgery; 60 could not.

Female patients, patients performing heavy manual labor, and those with postoperative bursitis were less likely to return to work by 6 months. Lack of tendon healing was not a risk factor for failing to return to work. 

Comment: It would have been interesting to know the actual time for return to work after cuff repair in this series of patients rather than choosing 6 months as an arbitrary point of division. In any event, this article suggests that the time to return to work may be substantially longer that what was assumed in an article claiming that cuff repair can save society over three billion dollars per year which assumed an average time off work after cuff repair of 28 days.

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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

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'