Our Summary

This research study looked at the best time to start physical therapy after a type of shoulder replacement surgery called reverse total shoulder arthroplasty (RTSA). Currently, there’s no standard recommendation on when to start moving the shoulder after this surgery. This is important because not moving the shoulder for a long time can be harmful, especially for older people, but moving it too soon could potentially cause complications like dislocation.

The researchers divided patients who had the surgery into two groups: one group started physical therapy immediately after surgery to increase their range of motion, and the other group waited six weeks before starting therapy. They followed these patients for at least a year to see if there were any differences in range of motion, patient-reported outcomes, and the rate of dislocation.

The study found that both groups had similar improvements in range of motion and patient-reported outcomes, with no significant difference in complications or use of pain medication. However, the group that started therapy later had a slightly better functional score (a measure of how well their shoulder was working) at six months after surgery.

The researchers concluded that starting physical therapy early after RTSA surgery could be beneficial, especially for older people, because it helps avoid the problems that can come from not moving the shoulder for a long time. However, both early and late start times for therapy led to significant improvements.

FAQs

  1. What is reverse total shoulder arthroplasty (RTSA) surgery?
  2. What were the results of the research study regarding the best time to start physical therapy after RTSA surgery?
  3. Can starting physical therapy late after RTSA surgery lead to complications or affect the functional score of the shoulder?

Doctor’s Tip

Therefore, a helpful tip a doctor might tell a patient about shoulder replacement surgery is to start physical therapy early after surgery to help improve range of motion and overall function of the shoulder. It is important to follow the guidance of your healthcare team and gradually progress with therapy to avoid complications. Additionally, be sure to communicate any concerns or changes in symptoms to your healthcare provider throughout the recovery process.

Suitable For

Patients who are typically recommended for shoulder replacement surgery, such as reverse total shoulder arthroplasty, include those with severe shoulder arthritis, rotator cuff tears that cannot be repaired, severe shoulder fractures, failed previous shoulder surgeries, and other conditions that cause significant pain and limited function in the shoulder. Additionally, patients who have not had success with conservative treatments such as physical therapy, medications, and injections may also be recommended for shoulder replacement surgery. It is important for patients to discuss their individual case with their healthcare provider to determine if shoulder replacement surgery is the best treatment option for them.

Timeline

Before shoulder replacement surgery:

  1. Patient experiences chronic shoulder pain and limited range of motion.
  2. Patient consults with a doctor and undergoes imaging tests to determine the need for surgery.
  3. Surgery is scheduled, and patient undergoes pre-operative preparation and education.

After shoulder replacement surgery:

  1. Patient undergoes reverse total shoulder arthroplasty surgery.
  2. Post-operative pain management and rehabilitation begin immediately.
  3. Patient is monitored for any complications, such as infection or dislocation.
  4. Physical therapy is started either immediately after surgery or after a six-week waiting period.
  5. Patient undergoes regular follow-up appointments to track progress and adjust treatment as needed.
  6. Patient gradually increases range of motion and strength in the shoulder through physical therapy.
  7. Patient experiences improved range of motion, decreased pain, and increased function over time.
  8. Patient may require ongoing physical therapy and follow-up care to maintain shoulder function and prevent complications.

What to Ask Your Doctor

  1. When is the best time to start physical therapy after a reverse total shoulder arthroplasty (RTSA) surgery?
  2. What are the potential risks and benefits of starting physical therapy immediately after surgery versus waiting six weeks?
  3. How will physical therapy help with range of motion and overall shoulder function after surgery?
  4. Are there any specific exercises or precautions I should be aware of during physical therapy?
  5. What signs or symptoms should I watch for that may indicate a complication or need for adjustment in my physical therapy regimen?
  6. How long should I expect to continue physical therapy after RTSA surgery?
  7. Will I need any additional support or assistance during my recovery and physical therapy sessions?
  8. Are there any lifestyle or activity modifications I should consider to protect my shoulder joint after surgery?
  9. What are the expected outcomes and success rates for patients who engage in physical therapy early versus late after RTSA surgery?
  10. Are there any other alternative or complementary therapies that may be beneficial for my recovery and shoulder function post-surgery?

Reference

Authors: Hagen MS, Allahabadi S, Zhang AL, Feeley BT, Grace T, Ma CB. Journal: J Shoulder Elbow Surg. 2020 Mar;29(3):442-450. doi: 10.1016/j.jse.2019.10.005. Epub 2020 Jan 7. PMID: 31924519