Shoulder Replacements

Week 3

Shoulder Complex

Not a single joint- glenohumeral, acromioclavicular, sternoclavicular, and
scapulothoracic joints
• Musculature acting on the joints
• Analyze dysfunction to determine deficits and develop interventions

Humeral Fracture

Hemiarthroplasty or humeral head replacement

Total Shoulder Arthroplasty (TSA)/Total Shoulder Replacement (TSR)

Humeral head replaced with prosthesis & glenoid is resurfaced or replaced with prosthetic component.
Degenerative or inflammatory conditions such as osteoarthritis

Reverse Total Shoulder Arthroplasty (RTSA)/ Reverse Total Shoulder Replacement (RTSR)

Rotator cuff is involved, and musculature can't support new joint. Ball and socket of glenohumeral joint are reversed. Degenerative or inflammatory conditions such as osteoarthritis or a TSR revision

Postoperative Care of Shoulder Replacement

Postoperative protocols will be surgeon specific
• In the initial postoperative phase, the glenohumeral joint must be maintained in the appropriate anatomic position
• A shoulder sling and swathe is typically used for 3 to 4 weeks
• NWB 6-8 weeks post op
• No shoulder extension past neutral, shoulder abduction past 45 degrees,
external rotation past approximately 30 degrees, and internal rotation past
approximately 60 degrees

Eval and Intervention

Evaluation:
ROM and strength are in elbow, wrist, hand
Sensation addressed distally
ADLs
• Intervention:
Appropriate ther-ex
Resumption of ADLs

Therapeutic Exercise Considerations

AAROM and PROM in protected ranges
• PROM: 90 degrees of shoulder flexion, 45 degrees of
shoulder abduction, and extension only to neutral
• Pendulum exercises: Remove sling, bend forward, 90 degrees shoulder flexion, with arm hanging perpendicular to floor. The arm may passively move in anterior-posterior motions, lateral motions, small clockwise circles, and small counter-clockwise circles
• 4-6 weeks before movement can increase; still WTB and lifting restrictions

Reverse Total Shoulder Replacement Considerations

PROM: 90 degrees of shoulder flexion, 45 degrees of shoulder
abduction, and extension only to neutral. Arm can cross over abdomen
• 5-7 days post op: Isometric exercise, AAROM 90 degrees of
flexion and abduction
• 2 weeks post-op: AROM

Sleeping Positions and Bed Mobility

The sling and swathe 4-6 weeks
• Support should be placed under the scapula or elbow for comfort and support while adhering to precautions
• Rolling onto non-operated shoulder
• Bed ladders, bed rails, or leg lifters

Upper Body Dressing and Bathing

Dressing
- Clothing chosen with sling wear in mind Sit, bend forward, extend elbow of operated arm first

Donning and doffing sling
• Bathing
- Sponge bath with arm supported
- Precautions need to be followed