Shoulder Replacement
What is a Shoulder Replacement or a Reverse Total Shoulder Replacement?
Shoulder replacement surgery, including reverse total shoulder replacement surgery, is a surgical procedure that can help alleviate chronic pain and restore function for individuals with debilitating shoulder conditions that is performed to replace a damaged or diseased shoulder joint with an artificial implant.
While traditional shoulder replacement involves replacing the damaged humeral head (ball) with a metal or ceramic prosthesis, reverse total shoulder replacement reverses the anatomy of the shoulder joint, placing the ball component on the glenoid (socket) side and the socket component on the humeral side. This reversal is beneficial for patients with severe arthritis or irreparable rotator cuff tears, as it relies on different muscles to provide shoulder movement and stability.
As physiotherapists, we play a vital role in helping patients navigate the journey from pre-operative preparation to post-operative rehabilitation.
Indications for Shoulder Replacement Surgery:
Shoulder replacement surgery may be recommended for individuals with advanced shoulder arthritis, rotator cuff tears, or traumatic injuries that have not responded to conservative treatments. Common indications include:
Osteoarthritis: Degenerative changes in the shoulder joint, such as cartilage breakdown and bone spurs, can cause pain, stiffness, and limited range of motion.
Post-Traumatic Arthritis: Previous shoulder injuries, such as fractures or dislocations, can lead to post-traumatic arthritis and chronic pain.
Fractures: Severe fractures that are unable to be splinted may require shoulder replacement.
Surgical Procedure:
During shoulder replacement surgery, the affected structures may be replaced with artificial implants. Surgery types can include:
Shoulder Arthroplasty:
In this procedure, the damaged humeral head is replaced with a metal ball and a long stem inserted and secured inside the humerus. Additionally, the glenoid surface is replaced and affixed to the scapula.
Reverse Shoulder Arthroplasty:
This technique reverses the joint's configuration, replacing the glenoid with a ball-like surface and the humerus with a concave, glenoid-like surface. It is typically indicated for individuals with a compromised rotator cuff.
Hemiarthroplasty:
With hemiarthroplasty, only the humeral head is replaced. A prosthetic metal implant is inserted into the humerus to form the new humeral head.
Joint Surface Replacement:
This procedure involves replacing only the surface of the humerus, usually performed in cases of arthritis to restore joint function.
Post-Operative Shoulder Replacement Surgery Physio & Rehab:
Physiotherapy plays a critical role in the rehabilitation & recovery process following shoulder replacement surgery. The physiotherapist's primary goals are to optimise healing, restore range of motion, improve strength and function, and facilitate the patient's return to activities of daily living.
In the early stages of rehabilitation, physiotherapy focuses on pain management, reducing inflammation, and protecting the surgical site. Gentle range of motion exercises are initiated to prevent stiffness and promote healing without placing excessive stress on the new joint.
As healing progresses, the physiotherapy program is advanced to include more challenging range of motion exercises to restore shoulder mobility. Strengthening exercises targeting the muscles surrounding the shoulder joint are introduced to improve stability and support the new implant. These exercises may include resistance training with bands or weights, as well as functional exercises to simulate activities of daily living.
Physiotherapists also provide education on proper movement mechanics, and activity modification to prevent complications and optimise long-term outcomes. Manual therapy techniques such as soft tissue massage, dry needling, joint mobilisations, and stretching can also be utilised to address any residual stiffness or muscle tightness.
Physio goals include:
Pain Management: Providing strategies for pain relief, including ice, compression and manual therapy techniques such as mobilisation and massage.
Range of Motion Exercises: Guiding patients through gentle shoulder exercises to regain flexibility and mobility.
Strengthening Exercises: Gradually introducing strengthening exercises to rebuild muscle strength and stability around the shoulder joint and upper limb.
Functional Training: Assisting patients in performing activities of daily living and gradually reintroducing sports-specific movements as appropriate.
Patient Education: Educating patients about proper shoulder mechanics, activity modifications, and strategies to prevent complications.
Taping and Bracing: Providing patients with supportive bracing and taping to help aid function and comfort.
Conclusion:
Shoulder replacement surgery can offer significant relief for individuals struggling with chronic shoulder pain and dysfunction. As physiotherapists, we are committed to supporting patients throughout their surgical journey, from pre-operative education to post-operative rehabilitation. By working closely with patients, collaborating with surgeons and following a comprehensive physiotherapy program, we can optimise outcomes and help individuals achieve their functional goals and return to their desired level of activity following shoulder replacement surgery.
If you or someone you know is recovering from a shoulder reconstruction, or considering shoulder replacement surgery, our physiotherapists at Brisbane Physiotherapy can help! Don't hesitate to reach out for expert guidance and support.
