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Our last blog discussed the purpose and benefit of a total shoulder replacement or arthroplasty (TSA).  Today’s blog will discuss what a reverse total shoulder arthroplasty (rTSA) is and why someone might need one.

Why would someone have a reverse total shoulder replacement versus a typical TSA?  This particular procedure is used for conditions including non-repairable rotator cuff damage in conjunction with arthritis, complex shoulder fractures, and revisions of failed conventional TSAs.  For more information about the anatomy and function of the rotator cuff, check out our past blog on the topic here. A traditional TSA can be very beneficial for pain related to arthritis at the shoulder; but if the rotator cuff is not functioning properly, then the traditional TSA will not be effective in restoring function to the shoulder.  The structure of a rTSA allows muscles other than those of the rotator cuff to assist with movement; therefore, it is a more viable option for individuals who have a non-functioning rotator cuff.

What is the structure of a rTSA? The normal anatomy of the shoulder is a ball and socket joint with the ball being the top of the humerus (upper arm bone) and the socket being the glenoid (cup like structure at the edge of the shoulder blade).  A rTSA reverses the ball and socket components of the shoulder anatomy.  Instead of the humerus forming the ball, an artificial metal ball is attached to the glenoid surface; and instead of the glenoid forming the socket, the head of the humerus is taken off and replaced with a plastic artificial socket.  This gives the deltoid muscle (a muscle that lays overtop of the rotator cuff) a biomechanical advantage in order to lift and move the arm.  If there is severe enough weakness in the muscles that rotate the shoulder outward (external rotators), then a surgeon may also perform a tendon transfer using the tendon from the latissimus dorsi muscle.

What can be expected from rehab following a rTSA?  The expectations for range of motion and strength are a little different between a TSA and a rTSA.  In the case of a rTSA, full motion is not expected.  Even though the deltoid muscle has the ability to lift the arm, it is not capable of producing the same range of motion as when the rotator cuff muscles are intact.  There is also the potential for external rotator weakness as previously discussed.  If a tendon transfer is not performed to correct a severe degree of external rotation weakness, then this will also limit the mobility of the arm following surgery.  Despite the limitation in full motion, satisfaction following a rTSA is typically very high.

Stay tuned for our next blog which discusses the rehab parameters for both a TSA and rTSA.  We hope that this blog was informative.  If you have any questions on this topic or any others in which you are interested, feel free to leave any questions, comments, or suggestions.

Resources:

http://orthoinfo.aaos.org/topic.cfm?topic=A00504

http://www.mayoclinic.org/reverse-shoulder-replacement-video/vid-20086567

http://www.jospt.org/doi/pdf/10.2519/jospt.2007.2562

http://www.brighamandwomens.org/patients_visitors/pcs/rehabilitationservices/physical%20therapy%20standards%20of%20care%20and%20protocols/shoulder_reverse_tsa_protocol.pdf

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Most people are at least somewhat familiar with total knee replacements, even if you don’t understand the full scope of the procedure; but total shoulder replacements are not quite as publicized.  Total shoulder replacements are a common procedure for shoulder ailments, but they are still far less common than total knee and total hip replacements.

Why does one undergo a total shoulder replacement?  Often pain from arthritis spurs an individual to decide to have a total shoulder replacement, also known as a total shoulder arthroplasty (TSA).  Osteoarthritis is also referred to a degenerative joint disease and results from gradual “wear and tear” on the joint from an accumulation of life’s activities.  The cartilage that typically protects the ends of the bones wears away which results in “bone on bone” rubbing at the shoulder joint when the arm is moved.  Arthritis can also develop in the shoulder from a traumatic injury like a fracture (broken bone) of the shoulder or arm, chronic rotator cuff injuries or weakness, or other injuries to the shoulder area that cause instability.  These injuries can result in a loss of function and the need for a TSA in the future.  Arthritis typically effects people around the age of 50, but can occur at a younger age especially if an injury occurred at the joint earlier in life.  Rheumatoid arthritis is a different arthritic condition that causes chronic inflammation around the joint resulting in cartilage loss, pain, and stiffness.  This condition usually presents itself earlier in life around the age of 30 and can also lead to the need for a TSA.  Another condition that can also lead to joint damage and the need for a TSA is avascular necrosis.  This condition occurs when the blood supply to the bone is disrupted resulting in degeneration of the joint.  It can occur for a variety of reasons including chronic steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease, and heavy alcohol use.

What does a total shoulder replacement entail?  The extent of a total shoulder replacement can vary based on the amount of damage along the joint surfaces.  The shoulder joint is what is called a ball and socket joint.  The top of the humerus bone which is located along the upper arm forms the ball of the joint and the socket of the joint is what is called the glenoid.  The glenoid is actually a portion of the shoulder blade that makes a shallow cup-like socket for the ball of the humerus to sit in.  The ball, the socket, or both can be replaced by removing the damaged portion of the joint and replacing it with an artificial component called a prosthesis.

Is a shoulder replacement right for you?  Conservative treatments like physical therapy for the shoulder should be attempted prior to undergoing a total shoulder replacement, because arthritis can often be managed with exercise programs and adjustments in form during various activities; but the condition can become severe enough that a TSA is the only option.  Severe shoulder pain that interferes with daily function, moderate to severe pain at rest that disrupts sleep, loss of motion or weakness at the shoulder that effects function, and a failure to improve with conservative treatments like physical therapy, anti-inflammatory medications, or cortisone injections are all reasons to consider a total shoulder replacement.  Individuals with depression, obesity, diabetes, Parkinson’s disease, multiple previous shoulder surgeries, shoulder joint infections, rotator cuff deficiency, and severely altered shoulder anatomy are not ideal candidates for the procedure.  Individuals with rotator cuff deficiency may instead be candidates for a reverse total shoulder replacement.  This procedure will be discussed more in depth in our next blog.  Talk to your doctor or physical therapist if you feel that a TSA may be right for you.

Resources:

http://orthoinfo.aaos.org/topic.cfm?topic=A00094

http://www.orthop.washington.edu/MatsenTSA.pdf

http://my.clevelandclinic.org/health/treatments_and_procedures/hic_Total_Shoulder_Joint_Replacement

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In case you were not aware, September is Pain Awareness Month.  In the past we have done several blogs related to pain including referred pain, the “no pain, no gain” philosophy, sciatic nerve pain, and fibromyalgia.  If you are interested in any of these topics related to pain, click on the hyperlinks provided or refer to the blog list on our website.  Pain is one of the body’s many ways of communicating with us.  Typically, pain is an indicator that something is amiss within the body.  This is why understanding pain is so important. 

Pain is a warning sign that the nervous system of the body produces in order to help protect our bodies from harm.  Individuals who experience pain from conditions like fibromyalgia or complex regional pain syndrome (CRPS) may have heard from someone along the way that their pain is all in their head.  While this is not the best way of approaching either of these conditions, there is some truth within this statement; however, it would be more accurate to say that ALL people’s pain is in their head.  Pain is the brain’s response to an irritating stimulus, but the triggers for some people may not be the same as the triggers for others.  One person may feel minimal to no pain when being pricked by a needle while another individual may feel that the pain produced by the same stimulus is the worst pain imaginable.  The same event has occurred for the two individuals, but each person’s brain processes the event differently. 

Acute pain is the type of pain that occurs immediately after a negative stimulus.  It causes the body to produce a pain signal warning the person that something is wrong.  Depending on the problem that caused the acute pain, once the cause is known and treated, then the pain will go away.In the case of chronic pain, pain is produced for an extended period of time (weeks, months, or years) following the negative stimulus.  Sometimes there is a continued cause for pain to occur over an extended period of time like arthritis or cancer; but often there is no longer a stimulus that is causing the pain to remain present.  Why chronic pain persists in some individuals and not in others is not fully understood; but, once again, the brain’s processing of pain is what allows the body to feel the continued sensation.  There is no true cure for chronic pain, but there are ways to manage it including physical therapy, medication, acupuncture, electrical stimulation, surgery, psychotherapy, relaxation and meditation therapy, biofeedback, and behavior modification.  It is important to note that avoiding activity and exercise does not help to overcome chronic pain.  In fact, use of a regular fitness routine can assist in managing the condition.  Arthritis, fibromyalgia, and CRPS are all examples of chronic pain conditions that respond negatively to a lack of activity.  A physical therapist can help you determine the proper balance of rest and activity depending on your pain condition. 

Resources:

https://www.nlm.nih.gov/medlineplus/pain.html

https://www.nlm.nih.gov/medlineplus/chronicpain.html

http://theacpa.org/September-is-Pain-Awareness-Month

 

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Disclaimer:  The information in this medical library is intended for informational and educational purposes only and in no way should be taken to be the provision or practice of physical therapy, medical, or professional healthcare advice or services. The information should not be considered complete or exhaustive and should not be used for diagnostic or treatment purposes without first consulting with your physical therapist, physician or other healthcare provider. The owners of this website accept no responsibility for the misuse of information contained within this website.