shoulder joint replacement (exam 2)

what can cause the shoulder to need replacement?

osteoarthritis

rheumatoid arthritis

humeral fractures

types of medical management

hemiarthoplasty

total shoulder replacement (TSR)

reverse total shoulder arthroplasty (RTSA)

hemiarthoplasty

replaces femoral head

total shoulder replacement (TSR)

The procedure involves replacing the head of the humerus (the "ball") and the glenoid (the "socket") with metal and plastic parts

reverse total shoulder arthroplasty (RTSA)

- reverses the normal anatomic relationship between the humerus head and the glenoid socket

- A ball is placed onto the socket & a cup or socket is placed on top of the humerus in place of the ball

postoperative considerations

1) soft tissue healing and proaction of the glenohumeral alignment are critical

2) pain, edema, and inflammation managed with physician-directed modalities

3) use of shoulder in sling or swathe for 3-4 weeks, weight bearing restricted 6-8 weeks

shoulder replacement PRECAUTIONS

-NO WEIGHT BEARING with surgical UE

-no lifting > 1-2 lbs

- avoid abduction past 45 degrees

- avoid ER past 30-60 degrees

-avoid IR past 60 degrees

- limit passive flexion 90-100

(not active just passive)

t/f OT can begin day 1 post if medically stable

true

OT goals

-restore safe occupational performance

- train ADLs/IADLs with adaptive strategies

- EDUCATE on PRECAUTIONS

-progressive UE functional mobility and strength

eval and intervention

1) asses motor, cognitive, and emotional factors

2) focus on ADLs, adaptive equipment, and compensatory methods (ex, dressing stick, one handed techniques)

3) progress AROM, strength, and activity tolerance

phase 1 (0-4 weeks) PP PHASE

-PROM only, pendulum exercise

goals: protect repair, manage pain and edema, and prevent stiffness.

(PROM ONLY within surgeon defined limits

Movements are restricted to the following ranges: shoulder flexion up to 90-100°, abduction up to 45°, and ER up to 30°. IR is limited to placing the hand on the abdomen only.

Once cleared by the surgeon, do Codman's pendulum exercises (gentle circular or lateral motions)

encourage (AROM) of distal joints (elbow, wrist, and hand) to support circulation and prevent edema.

During rest, the shoulder should be maintained in a neutral alignment

phase 2 (4-6 weeks) AAROM, light isometrics

Active-assisted range of motion (AAROM) and light isometric exercises

introduce AAROM - AROM transition

( table slides, dowel exercises, and incline board pushing)

flexion tolerance may increase to 70° and ER to 60°.

Begin active-assisted exercise: (Overhead pulleys, wall slides, and supine dowel movements)

Light isometric exercises, such as scapular retraction, can begin as tolerated;

IMPORTANT: lifting and weight-bearing activities remain restricted at this stage.

phase 3 (6-12 weeks) STRENGTHEN

Gradual strengthening, closed-chain activities.

- Progress to light strengthening:

- scapular stabilization (elevation, depression, retraction).

- shoulder adduction, flexion, and rotation with light weights.

-Closed-chain activities (e.g., wall push-ups, prone-on-elbows).

-Restore functional motion through all planes.

phase 4 (12+ weeks)

Full AROM, return to occupations

reverse total shoulder replacement protocol

Used for rotator cuff-deficient

shoulders.

PROM limited to 45°

flexion/abduction, neutral external

rotation.

Begin pendulum exercises ~day 1.

AAROM starts around 7-10 days if

stable.

Full AROM expected by 12 weeks if

healing progresses.

RTSR PHASE 1 (0-2 WKS)

PROM (Flex less than or equal to 90, abd less than or equal to 45)

codeman's pendulums only with surgeon approval

AVOID: ADD+IR

RTSR PHASE 2 (2-6 wks)

Gentle AAROM; light deltoid/scapular isometrics;

ER less than or equal to 30°

RTSR PHASE 3 (6-12 wks)

Controlled AROM, light resistance (deltoid focus);

avoid resisted IR or extension