Abstract
This article provides an anatomical and biomechanical framework for the postoperative
management and progression of treatment for shoulder arthroplasty. The clinical relevance
of normal shoulder anatomy, biomechanics, and pathomechanics related to this surgery
is emphasized to provide the reader with an understanding of the rationale for treatment.
We review the rehabilitation implications of surgical indications and technique for
both traditional total shoulder arthroplasty and reverse total shoulder arthroplasty
procedures with an emphasis on biomechanical considerations. Relevant factors that
affect rehabilitation outcomes are discussed along with supporting evidence from the
literature. Principles to guide and progress treatment are highlighted with a discussion
on return to sports with the ultimate objective of providing a comprehensive approach
for successful rehabilitation.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand TherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Patient reported activities after shoulder replacement: total and hemiarthroplasty.J Shoulder Elbow Surg. 2011; 20: 273-280
- Postoperative rehabilitation of patients with shoulder arthroplasty—a review on the standard of care.Int J Phys Med Rehabil. 2014; S5: 001
- Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015.J Shoulder Elbow Surg. 2010; 19: 1115-1120
- Increasing incidence of shoulder arthroplasty in the United States.J Bone Joint Surg [Am]. 2011; 93: 2249-2254
- An analysis of factors affecting the long-term results of total shoulder arthroplasty in inflammatory arthritis.J Arthroplasty. 1988; 3: 123-130
- Glenohumeral joint replacement and postoperative rehabilitation.Phys Ther. 1975; 55: 850-858
- Rehabilitation following total shoulder arthroplasty.J Orthop Sports Phys Ther. 2005; 35: 821-836
- Shoulder replacement.in: Di Giacomo G. Bellachioma S. Shoulder Surgery and Rehabilitation. Springer, Basel, Switzerland2016: 67-92
- Rehabilitation after total shoulder arthroplasty.J Arthroplasty. 2001; 16: 483-486
- Is a formal physical therapy program necessary after total shoulder arthroplasty for osteoarthritis?.J Shoulder Elbow Surg. 2010; 19: 570-579
- Postoperative rehabilitation following total shoulder arthroplasty.Orthop Clin North Am. 1998; 29: 535-547
- Rehabilitation following total shoulder arthroplasty.Clin Orthop Relat Res. 1994; 307: 70-85
- Glenohumeral arthritis and its management.in: Rockwood C. Matsen F. Wirth M. The Shoulder. Saunders, Philadelphia, PA1998: 840-964
- The biomechanics of total shoulder arthroplasty.Operat Tech Orthop. 2002; 12: 2-9
- Kinesiology of the shoulder complex.J Orthop Sports Phys Ther. 1987; 8: 438-450
- Reverse shoulder arthroplasty.Orthop Clin North Am. 2013; 44 (x): 389-408
- Anatomy and biomechanics of the shoulder.Orthop Clin North Am. 2000; 31: 159-176
- The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder.Am J Sports Med. 1990; 18: 449-456
- Observations of the function of the shoulder joint. 1944.Clin Orthop Relat Res. 1996; : 3-12
- Dynamic glenohumeral stability provided by the rotator cuff muscles in the mid-range and end-range of motion. A study in cadavera.J Bone Joint Surg [Am]. 2000; 82: 849-857
- Timing of rotator cuff activation during shoulder external rotation in throwers with and without symptoms of pain.J Orthop Sports Phys Ther. 2005; 35: 812-820
- Three-dimensional analysis of the width of the subacromial space in healthy subjects and patients with impingement syndrome.AJR Am J Roentgenol. 1999; 172: 1081-1086
- The value of ultrasound after shoulder arthroplasty.Skelet Radiol. 2002; 31: 695-701
- Total shoulder arthroplasty: indications, technique, and results.Operat Tech Orthop. 2011; 21: 28-38
- Importance of the subscapularis muscle after total shoulder arthroplasty.Clin Biomech (Bristol, Avon). 2013; 28: 146-150
- Soft tissue balancing in total shoulder replacement.Curr Rev Musculoskelet Med. 2014; 7: 16-21
- Integrity and function of the subscapularis after total shoulder arthroplasty.J Shoulder Elbow Surg. 2010; 19: 1085-1090
- Rupture of the subscapularis tendon after shoulder arthroplasty: diagnosis, treatment, and outcome.J Shoulder Elbow Surg. 2005; 14: 492-496
- Proposal for SICSeG guidelines for rehabilitation after anatomical shoulder prosthesis in concentric shoulder osteoarthritis.Musculoskelet Surg. 2013; 97: 31-37
Ellenbecker TS, Bailie DS. Shoulder arthroplasty in the athletic shoulder. In: Wilkes KE, Reinhold MM, Andrews JR (Eds), The Athlete's Shoulder; Churchill Livingstone/Elsevier; Philadelphia, PA, 2009:315.
- Total shoulder arthroplasty.J Bone Joint Surg [Am]. 1987; 69: 865-872
- Treatment of locked posterior fracture-dislocations of the shoulder by total shoulder arthroplasty.J Shoulder Elbow Surg. 1997; 6: 11-17
- Surgical treatment of osteoarthritis of the shoulder.Rheum Dis Clin North Am. 1988; 14: 591-611
- Long-term results of cemented metal-backed glenoid components for osteoarthritis of the shoulder.J Bone Joint Surg [Am]. 2009; 91: 160-166
- Preoperative patient expectations of total shoulder arthroplasty.J Bone Joint Surg [Am]. 2011; 93: 2110-2115
- Factors affecting the outcome of total shoulder arthroplasty.Am J Orthop. 2001; 30: 613-623
- Cementless surface replacement arthroplasty of the shoulder. 5- to 10-year results with the Copeland mark-2 prosthesis.J Bone Joint Surg [Br]. 2001; 83: 213-221
- Total shoulder replacement in rheumatoid disease: 7- to 13-year follow-up of 37 joints.J Bone Joint Surg [Br]. 1997; 79: 68-72
- Shoulder arthroplasty for proximal humeral nonunions.J Shoulder Elbow Surg. 2002; 11: 114-121
- Shoulder arthroplasty for proximal humeral malunions: long-term results.J Shoulder Elbow Surg. 2002; 11: 122-129
- Glenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency.J Arthroplasty. 1988; 3: 39-46
- Cuff-tear arthropathy.J Bone Joint Surg [Am]. 1983; 65: 1232-1244
- Clarification of the role of the supraspinatus muscle in shoulder function.J Bone Joint Surg [Am]. 1986; 68: 398-404
- The rotator cuff-deficient arthritic shoulder: diagnosis and surgical management.J Am Acad Orthop Surg. 1998; 6: 337-348
- The biomechanics of reverse anatomy shoulder replacement - a modelling study.Clin Biomech. 2009; 24: 254-560
- How do deltoid muscle moment arms change after reverse total shoulder arthroplasty?.J Shoulder Elbow Surg. 2016; 25: 581-588
- How sensitive is the deltoid moment arm to humeral offset changes with reverse total shoulder arthroplasty?.J Shoulder Elbow Surg. 2016; 25: 998-1004
- Primary shoulder reverse arthroplasty: surgical technique.Orthop Traumatol Surg Res. 2014; 100: S181-S190
- Reverse total shoulder arthroplasty—biomechanics and rationale.Operat Tech Orthop. 2011; 21: 52-59
- Arc of motion and socket depth in reverse shoulder implants.Clin Biomech (Bristol, Avon). 2009; 24: 473-479
- How reverse shoulder arthroplasty works.Clin Orthop Relat Res. 2011; 469: 2440-2451
- Rehabilitation following reverse total shoulder arthroplasty.J Orthop Sports Phys Ther. 2007; 37: 734-743
- Biomechanical effect of latissimus dorsi tendon transfer for irreparable massive cuff tear.J Shoulder Elbow Surg. 2013; 22: 150-157
- Scapulohumeral rhythm in shoulders with reverse shoulder arthroplasty.J Shoulder Elbow Surg. 2015; 24: 1129-1134
- Kinematic analysis of the scapula after total anatomic and reverse shoulder arthroplasty.Ann Phys Rehabil Med. 2016; 59S: e117-e118
- Complications with reverse total shoulder arthroplasty and recent evolutions.Int Orthop. 2013; 37: 843-851
- Moment arms of the shoulder musculature after reverse total shoulder arthroplasty.J Bone Joint Surg [Am]. 2010; 92: 1221-1230
- Acromial and scapular spine fractures after reverse total shoulder arthroplasty.Shoulder Elbow. 2016; 8: 90-100
- What is a successful outcome following reverse total shoulder arthroplasty?.Open Orthop J. 2010; 4: 157-163
- Reverse total shoulder arthroplasty: a review of results according to etiology.J Bone Joint Surg [Am]. 2007; 89: 1476-1485
- Clinical outcomes of reverse total shoulder arthroplasty in patients aged younger than 60 years.J Shoulder Elbow Surg. 2014; 23: 395-400
- Complications of shoulder arthroplasty.J Bone Joint Surg [Am]. 2017; 99: 256-269
- Complications of total shoulder arthroplasty.J Bone Joint Surg [Am]. 2006; 88: 2279-2292
- Return to sport after shoulder arthroplasty: a systematic review and meta-analysis.Knee Surg Sports Traumatol Arthrosc. 2017; (In press)
- Do patients return to sports and work after total shoulder replacement surgery?.Am J Sports Med. 2015; 43: 423-427
- Long-term activity restrictions after shoulder arthroplasty: an international survey of experienced shoulder surgeons.J Shoulder Elbow Surg. 2011; 20: 281-289
- Return to sports after shoulder arthroplasty: a survey of surgeons' preferences.J Shoulder Elbow Surg. 2012; 21: 554-560
- Athletic activity after joint replacement.Am J Sports Med. 2001; 29: 377-388
JHT Read for Credit
Quiz: #489
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.It is critical to protect the repair of the _______________ in devising the rehab plan
- a.suprascapular nerve
- b.deltoid
- c.posterior cuff
- d.subscapularis
- a.
- #2.Normal shoulder kinematics involve
- a.secondary activation of the rotator cuff
- b.primary activation of the rotator cuff
- c.a force couple combining activation of the deltoid and the rotator cuff
- d.a force couple combining activation of the deltoid and the lower trapezius
- a.
- #3.A reverse shoulder arthroplasty employs
- a.a convex element which is affixed to the scapula and articulates with a relatively shallow proximal humeral element
- b.a convex proximal humeral element
- c.a deeply concave proximal humeral element which articulates with an intact glenoid
- d.an externally rotated proximal humeral element and an internally rotated glenoid element
- a.
- #4.In order to reduce pain and increase function shoulder arthroplasty attempts to
- a.correct articular cartilage defects
- b.restore proper biomechanics and joint kinematics
- c.denervate the glenohumeral joint
- d.partially fuse the glenohumeral joint
- a.
- #5.The incidence of shoulder arthroplasty has increased significantly in the past several years
- a.false
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Accepted:
May 19,
2017
Received in revised form:
May 19,
2017
Received:
February 22,
2017
Identification
Copyright
© 2017 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
