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Understanding Shoulder Replacement Surgery By Kimberly Savato, DPT of All-Care Physical Therapy Center, Manchester, NJ 732-657-7900 Total Shoulder Replacement

Shoulder Replacement Options: Total v. Reverse Shoulder Replacement

The total shoulder arthroplasty (TSA) was first performed in the United States in the 1950’s. According to the Agency for Healthcare Research and Quality, about 53,000 people in the U.S. have their shoulder replaced each year. This compares to more than 900,000 Americans a year who have knee and hip replacements. The main goal of shoulder replacement surgery is to decrease pain, while also increasing mobility, strength, and function in order to help the patient return to normal life.

• Total shoulder replacement: TSA is a surgical procedure that replaces the damaged glenohumeral joint with artificial components called prostheses. Typically, the head of the humerus and the glenoid cavity are both replaced. The damaged humeral head is replaced with a metal ball and stem, which is placed into the shaft of the humerus. The glenoid cavity is replaced with a new smooth plastic surface.

Anatomy of the shoulder (glenohumeral joint) The shoulder is made up of three bones: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collar bone). Much like a ball and socket joint, the head of the humerus (the ball) fits into the socket of the scapula, called the glenoid cavity; this makes up the glenohumeral joint. The second portion of the shoulder is called the rotator cuff, and is made up of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis). These muscles aid in holding the head of the humerus into the glenoid cavity during shoulder elevation, so partial dislocation (subluxation) does not occur.

Who needs a total shoulder replacement? Increased shoulder pain can be debilitating, and can significantly impact one’s quality of life. Patients with progressing shoulder pathology, persistent pain, and loss of function, benefit from a total shoulder replacement. These pathologies include: • advanced osteoarthritis (OA) • rheumatoid arthritis • disease of the rotator cuff • osteonecrosis • fractures of the humeral head Advanced OA is the most common reason to have surgery. Patients frequently hear the term “bone on bone,” which means there has been a significant deterioration of the normal smooth cartilage that lines the joint. Smooth cartilage is important because it allows the ball and socket to glide against one another during movement. Surgical management is considered when conservative treatment, such as rehabilitation, corticosteroid injection, anti-inflammatory medication, and pain medication (analgesics) fail to provide relief.

Is a total shoulder replacement right for you? The decision to have shoulder replacement surgery should be a mutual decision among you, your family, your family physician, and your orthopedic surgeon. As mentioned above, if conservative treatment was performed without relief of symptoms, then shoulder replacement surgery can be a great option to help increase your functional independence and regain your quality of life.

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• Reverse shoulder replacement: If you have severe rotator cuff damage or a complete rotator cuff tear, then a reverse total shoulder replacement might be better for you as a total shoulder replacement could still leave you with pain and the inability to lift your arm above shoulder level. In a reverse total shoulder replacement, the socket and metal ball are switched. The metal ball replaces the shoulder socket and a plastic socket is attached where the head of the humerus was. In addition, due to the irreparable damage to the rotator cuff, the deltoid muscle now becomes the primary mover during shoulder elevation.

How physical therapy can help after surgery Although results of a TSA vary from patient to patient depending upon the underlying diagnosis, the results of having TSA are very satisfactory. Physical therapy after a TSA has a high success rate because the procedure involves soft tissue reconstruction of ligaments, muscles, and tendons. Physical therapists are well educated in the precautions and post-surgical care following a TSA in order to increase overall functional activity. The primary goal of shoulder replacement surgery is pain relief, along with the benefit of restoring motion and strength in order to return to sport or other recreational activities. Patients are permitted to use their hand and wrist soon after surgery, and their elbow and shoulder approximately six weeks after surgery for light activity. Unrestricted, active use of the arm may begin as early as eight weeks after surgery. It is important to realize that patients typically will not be pain free until about 6-12 months after surgery. After one year, 95% of TSA patients enjoy pain-free function, which enables them to exercise the shoulder and return to the activities they enjoy.

Kimberly Salvato, DPT Manchester Physical Therapist Kimberly Salvato received her Bachelor’s of Science in Biology and minor in Behavioral Neuroscience at the Richard Stockton College of New Jersey in 2012. Following the completion of her undergraduate degree, Kimberly attended graduate school at the University of the Sciences in Philadelphia and received her Doctor of Physical Therapy in 2015. As a student, Kimberly received extensive training treating patients post-stroke in an acute setting and patient post-surgical in an outpatient orthopedic setting. Kimberly then spent four months on her last affiliation in orthopedics and sports medicine, where she studied under renowned sports physical therapists, athletic trainers, and strength and conditions specialists. Kimberly learned valuable knowledge working with high school and college athletes, predominately with ACL and meniscal injuries. Kimberly believes in using evidenced based practice (EBP) in order to provide high-quality care to her patients. She has even participated in a group research project examining the efficacy of Thera-Band elastic bands versus free weights when performing external rotation of the shoulder, which she hopes will become published. Kimberly’s approach to treatment utilizes various techniques she has learned including: Instrument Assisted Soft Tissue Mobilization (IASTM), Kinesio Taping Method, and manual therapy techniques including Maitland, Mulligan, and McKenzie approaches.

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May/June 2017

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