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Surgical Treatment


On the following pages we have described two typical shoulder surgical procedures, total shoulder replacement and reverse total shoulder replacement along with the necessary rehabilitation that must follow in order for you to achieve a successful outcome. Your shoulder injury or condition makes you a candidate for one of these surgeries. Your surgeon may describe your specific surgery in greater detail and be more specific about the required rehabilitation.

Total Shoulder Replacement

Total shoulder replacement, also known as total shoulder arthroplasty (TSA), is a procedure for treating the severe pain and stiffness that often result at the end stage of various forms of arthritis or degenerative joint disease of the shoulder joint. The primary goal of total shoulder replacement surgery is pain relief, with a secondary benefit of restoring motion, strength, function, and assisting with returning patients to an activity level as near to normal as possible. Many patients return to the sports they love like tennis, golf, and swimming, while also pursuing personal health initiatives such as individual training, yoga and pilates. Painful shoulder arthritis refers to the disappearing of the normally smooth cartilage surfaces of the shoulder, which permit the ball and socket to smoothly glide against one another. This disappearance of cartilage covering results in a “bone on bone” joint. Thus new surfaces provide the answer for restoration of comfort.

During the operation implants made of plastic and metal are placed to create new joint surfaces. The operation requires an incision, the arthritic ball is removed and replaced by a metal ball (prosthesis) that attaches to a metal stem, which goes inside the upper humerus bone (similar to the way in which ice cream sits on top of a cone). The arthritic socket is covered by a smooth plastic socket, also called a prosthesis. It is the smooth metal ball moving on the smooth plastic socket that relieves pain and improve shoulder motion.

Your New Shoulder

Reproduced with permission from OrthoInfo. ©American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org

Immobilization and Rehabilitation

Pre-Operative
Your surgeon may refer you to physical therapy or occupational therapy prior to your surgery. The purpose is to restore as much of your normal strength and range of motion as possible in order to attain the best outcome. Additionally, education on the recovery process and function after your total shoulder replacement may be provided.

Post-Operative
After surgery, you will wear a removable sling. Wearing time recommendations for your sling are for 4-6 weeks and will be directed by your surgeon. Your surgeon will decide on the type of sling you will be required to wear. The first 6 weeks do avoid extreme arm positions, such as reaching behind your body or moving your arm straight out to the side or lifting anything heavier than 5 pounds. Also, avoid pushing yourself up out of a chair or bed with your operated side, as this requires forceful muscle contractions.

During this period, patients often begin physical or occupational therapy and may be asked to perform certain range of motion exercises. These exercises are important for optimal recovery and will not cause harm to the shoulder. Generally, during this period you will only be allowed to move the operated arm passively (no resistance) by using your non-operated arm or an assistive device (cane/ dowel).

As the rehabilitation program progresses, you will be allowed to actively move the arm on its own and begin strengthening. Pay careful attention to your surgeon and therapist’s directions and perform the exercises exactly as you are instructed. Your strengthening program will progress individually, based on the HSS rehabilitation total shoulder arthroplasty guidelines. Total shoulder replacement provides outstanding pain relief and patient satisfaction is typically very high.

 

"Reverse" Total Shoulder Replacement

The “reverse” total shoulder replacement– RTSA is an alternative surgery for patients who have torn their rotator cuff in addition to having developed arthritis. The torn rotator cuff is considered non-functioning. Because of this the rotator cuff cannot be relied upon to stabilize and move the shoulder. The reverse total shoulder prosthesis is designed with a socket where the ball (head of the humerus) is normally located and a ball where the socket (glenoid) is usually located. The reverse design allows the shoulder now to rely on the deltoid muscle for stability and movement.

Your New Shoulder

Reproduced with permission from OrthoInfo. ©American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org

Immobilization and Rehabilitation

After surgery, you will be wearing a removable sling. Wearing time recommendations for your sling are for 2 -4 weeks and will be directed by your surgeon. Your surgeon will also decide on the type of sling you will be required to wear.

Your surgeon and therapist may instruct you to do gentle range of motion exercises to increase your mobility and endurance. A formal therapy program may also be recommended to strengthen your shoulder and improve flexibility. During the first 6 weeks do avoid extreme arm positions, such as reaching behind your body or moving your arm straight out to the side or lifting anything heavier than 5 pounds. Also, avoid pushing yourself up out of a chair or bed with your operated side, as this requires forceful muscle contractions.

As the rehabilitation program progresses, you will be allowed to actively move the arm on its own and begin strengthening. Pay careful attention to your surgeon's and therapist’s directions and perform the exercises exactly as you are instructed. Your strengthening program will be based on the HSS rehabilitation reverse total shoulder arthroplasty guidelines. Reverse total shoulder replacement provides outstanding pain relief and patient satisfaction is typically very high.