Friday, April 19, 2024

Reverse Shoulder Replacement Surgery Recovery Time

How Do I Know When Im Ready For A Shoulder Replacement Surgery

What is the recovery time of Reverse Shoulder replacement surgery?

If you have pain in your shoulder, limited function and difficulty sleeping, consider getting cortisone injections or taking arthritis medications. If you find the injections and medications dont provide relief for your shoulder pain, then it is time to discuss a shoulder replacement, and whether it should be a partial or total shoulder replacement.

Three To Six Months Post

As long as patients follow all post-surgical care instructions and stay committed to physical therapy routines, they should be feeling strong and healthy within three months of treatment.

Minor discomfort may still be an issue periodically, but it should be easily managed with over-the-counter pain medication. Although each recovery process is unique, most patients are able to resume all of their usual activities between three and six months of surgery, including a moderate exercise routine. As an added precaution, contact sports or extreme exercises should still be avoided.

Exercises During The Early Postoperative Period May Include:

  • Pendulums – Hold onto a chair, table or bed. Bend forward and let your arm hang loosely toward the ground. Shift your hips gently side to side so the arm swings like an elephants trunk.

The next phase of rehabilitation, weeks 6-12, typically involves continued management of pain and swelling as well as stretching and strengthening exercises to gently increase range of motion and restore strength to the muscles around the shoulder joint.

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What Shoulder Conditions Warrant Reverse Total Shoulder Replacement

The main reason to consider a reverse prosthesis is when there is arthritis of the shoulder joint and the rotator cuff tendons are torn or gone. This is the most common surgical indication for a patient considering a reverse prosthesis. In this situation this operation will give the patient significant pain relief and may also help with range of motion of the shoulder. While range of motion after a reverse prosthesis may not be completely normal, it is typically improved over the motion previously lost due to the arthritis and pain.

Another reason to have a reverse prosthesis is if the rotator cuff tendons are all torn and one cannot lift the arm high enough to function. Typically in this case the shoulder is not painful but the inability to lift the arm is very disrupting to the ability to function in life. When the patient goes to lift the arm there is a prominence on the front of the shoulder, and this is called an anterior-superior migration or subluxation of the shoulder. In these cases pain may or may not be a major factor for the reverse prosthesis, but the main reason for the replacement is to regain motion and function.

Other reasons to have a reverse prosthesis are some fractures of the shoulder area, particularly ones that involve the proximal humerus where the ball attaches to the shaft of the bone. In some instances, the bone is broken into many pieces or the ball may be split into parts.

At The Surgical Center

How To Reduce Surgery Recovery Time  14 Things Your Surgeon Wont Tell ...

Before you go home, a nurse or physical therapist will show you how to wear a shoulder sling to support your arm. You will need to wear the sling for 2 to 4 weeks after surgery. A physical therapist will also teach you simple exercises you should do at home to promote shoulder healing, strength and flexibility.

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What Does Reverse Total Shoulder Replacement Recovery Involve

You can expect to spend a few months recovering from reverse total shoulder replacement. For the first few weeks, you will need to protect your arm by wearing a sling. Afterward, you will spend time doing physical therapy exercises either at home or in a clinical setting. Your surgeon will discuss your specific course of recovery with you as you prepare for your procedure.

How Do I Know If I Need A Total Shoulder Replacement

The orthopedic surgeon will do a variety of tests to determine if a patient is a suitable candidate for total shoulder replacement surgery. A physical exam of the shoulder is performed to determine the range of motion and stability, and to assess the strength of the joint. X-rays will be taken to determine the severity of arthritis, possible fractures, bony overgrowth areas, or cartilage trapped or floating in the joint. An MRI may be done to determine the quality of the bone. Depending on other patient conditions, additional tests may be required.

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Candidates For A Reverse Shoulder Replacement

If you have a completely torn rotator cuff, a complex shoulder fracture, chronic shoulder dislocation, severe shoulder pain, cuff tear arthropathy, and have tried numerous other treatments, then you may be a candidate for this sort of shoulder surgery.

Its not an easy decision and may require some time to recover, but if your shoulder joint issues are having a significant negative impact on your life, it may very well be worth it. Consult with your doctor or orthopaedic surgeon to determine the best solution for you and your lifestyle.

Analysis And Aetiology Of Pain

Reverse Shoulder Replacement Surgery & Rehab (NEW)

It is important to determine whether or not there was a trauma before the onset of pain, and whether the pain occurs at rest or when using the arm. Acute pain after a significant trauma can be caused by fractures , dislocation or rotator cuff injuries. Acute pain can also occur without trauma, and the most common aetiology during the initial postoperative years is a fracture of the acromion or spine of scapula.37 In a few cases, sudden pain has been caused by spontaneous periprosthetic fractures and coracoid process fractures.8 In these cases, the pain is usually more intense when the patient is trying to use the arm and reduced when the arm is at rest. A gradual increase in pain at rest and stiffness should lead to a high suspicion of infection.9,10 Diagnosis of an infection after RSA can be challenging, particularly if the blood tests are normal.1116 Loosening of the prosthetic components can cause pain and loss of function, although aseptic loosening is rare during the initial postoperative years.1720

Postoperative radiographs after revision of a failed anatomical arthroplasty to a reverse shoulder arthroplasty. Radiographs showing a spontaneous periprosthetic fracture causing intense pain. Treated non-operatively in a brace. Radiograph showing callus formation and clinical improvement.

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Reverse Shoulder Replacement Vs Total Shoulder Replacement

An image of a total shoulder replacement

A total shoulder replacement requires an intact rotator cuff muscle in order to balance the shoulder placement and help provide the necessary functionality to the replacement joint.

An image of a reverse shoulder replacement

What makes a reverse shoulder replacement different from a total shoulder replacement is that the glenoid and humerus components are switched , and it relies on the deltoid muscle instead of the rotator cuff. This type of surgery is gaining popularity worldwide due to its versatility.

Diagnosing Conditions That May Be Treated With A Shoulder Replacement

To diagnose arthritis in the shoulder, a doctor will order a series of standard . A may also be necessary to evaluate a patient’s bone integrity, and magnetic resonance imaging may be ordered to determine the condition of important surrounding soft tissues, such as the rotator cuff tendon.

If the doctor suspects there may be nerve damage, based discussions with the patient, an or nerve conduction study may be ordered to evaluate the nerves that feed the important muscles of the shoulder.

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How Does Your Shoulder Work

Similar to the hip joint, your shoulder is a large ball and socket joint. It can rotate through a greater range of motion than any other joint in your body. The shoulder joint is made up of bones, tendons, muscles and ligaments which hold the shoulder in place and allows for its movement. Bones of the shoulder joint include the Clavicle , Scapula and Humerus .

Your clavicle connects with the shoulder blade at the acromioclavicular joint, or A.C. joint. The clavicle attaches your shoulder to your rib cage and holds it out and away from your body. The rounded head of the humerus, or upper arm bone, rests against the socket in the shoulder blade. The surfaces of the bones where they touch are covered by a smooth substance called cartilage that protects your bones and enables them to glide and move easily. The muscles and tendons that surround the shoulder provide stability and support. A thin, smooth tissue called the synovial membrane covers all remaining surfaces inside the shoulder joint. In a healthy shoulder, this membrane makes a small amount of fluid that lubricates your cartilage and eliminates almost any friction in your shoulder.

Why Is Reverse Total Shoulder Replacement Performed

Dislocated total reverse shoulder replacement after 6 weeks and first ...

Often, you can experience shoulder arthritis along with damage to the rotator cuff, which is the group of muscles that hold your shoulder in place and allow you to move your arm in different directions. If you suffer from both conditions at the same time, a total shoulder replacement procedure may not provide sufficient relief, and reverse shoulder replacement is an alternative option. We use reverse total shoulder replacement surgery to address a variety of conditions including:

  • Shoulder arthritis
  • Proximal humerus fractures

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Is A Reverse Shoulder Replacement Surgery Covered By Insurance Or Medicare

The cost of reverse shoulder replacement surgery depends on your location, surgical center, and the complexity of your surgery. You might have insurance coverage for your reverse shoulder replacement surgery.

Since reverse shoulder replacement surgery is used to treat arthritis and severe rotator cuff tears, it can be considered medically necessary. Under most insurance plans, including Medicare, this means it qualifies for coverage.

That said, its important to check your plan. You might need to meet certain requirements before coverage is offered. If your shoulder doesnt meet your insurance companys criteria, you might be denied surgical coverage.

How Long Does Shoulder Pain Last After Surgery

Post surgery pain is well managed by nurses and doctors and typically does not last long. In the 1-3 days following surgery, most people will experience pain at the incision site and will be given pain medication at home. Pain can also be managed by cold packs and additional treatment provided by a physical therapist.

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How Can Physical Therapy Help

Physical therapy can help a person recover from a total shoulder replacement by guiding the individual through a structured exercise protocol, improving shoulder function and range of motion, and allowing you to get back to pain-free activities.

Article By: Bridgette Sakar, DPT, PT, OCS

Bridgette Sakar began her physical therapy career 7 years ago. Bridgette loves working with the athletic population and believes that an active body is a healthy body. Bridgette is a graduate of the HSS Ivy Rehab Orthopedic Residency Program and is a board-certified Orthopedic Clinical Specialist. She currently specializes in orthopedic and sports injuries. Bridgette currently treats patients at Ivy Rehab Physical Therapy in Denville, NJ.

An Overview On Reverse Shoulder Replacement

How Long Is Recovery From a Reverse Shoulder Replacement?

Shoulder arthritis causes pain, swelling and inflammation and is quite common in the older adult population. Arthritis can develop from a previous shoulder injury or from natural wear and tear and aging of the joint. When the cartilage of the ball and socket begins to wear away, conservative measures such as rest, ice and anti-inflammatory medications can alleviate the symptoms. In some cases, along with cartilage deterioration, the rotator cuff may tear or become dysfunctional. Alternatively, fractures or prior surgery can cause significant deformity of the normal anatomy and functional deficits. If the condition progresses and all other treatment options fail, a reverse shoulder replacement may be recommended by Dr. Nikhil Verma, shoulder surgeon serving the communities of Chicago, Westchester, Oak Brook and Hinsdale, Illinois.

Reverse shoulder replacement may be a recommended shoulder treatment for patients who have developed a complex type of shoulder arthritis called rotator cuff tear arthropathy. This condition occurs when the muscles that help center the ball in the socket move higher than the socket because of long standing rotator cuff tears. A rotator cuff tear that cannot be repaired and a failed total shoulder replacement are additional shoulder injuries that can be effectively treated by this procedure.

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Physical Therapy And Recovery

Convalescent assistance

Individuals usually require some assistance with self-care activities of daily living shopping and driving for at least six weeks after surgery. They usually go directly home after this surgery especially if there are people at home who can provide the necessary assistance or if such assistance can be arranged through an agency. In the absence of home support a convalescent facility may provide a safe environment for recovery.

Recovery of comfort and function after shoulder arthroplasty continues for many months after the procedure. Improvement in some activities may be evident as early as six weeks. With persistent effort individuals can make progress for as long as a year after surgery.

Physical therapy

Limited use after total shoulder replacement with a reversed prosthesis is critical for protection during the early phases of healing. In most cases we keep the arm in a sling for six weeks after the procedure to allow for healing of the soft tissues. Most individuals find the recovery of comfort and function can be accomplished without formal physical therapy.

Rehabilitation options

It is often most effective for the individual to carry out her or his own rehabilitation at home. Often no physical therapy is recommended.

Can rehabilitation be done at home?

In general the rehabilitation is best performed by the individual at home. Occasional visits to the surgeon or therapist may be useful to check the progress and to review the program.


What Is Reverse Total Shoulder Replacement

Reverse total shoulder replacement gets its name because instead of replicating the shoulders normal anatomy, it does the opposite. Surgeons fix the metal ball to the socket and attach the plastic socket to the top of the humerus.

People with damaged rotator cuffs, fractured shoulders, or a failed prior total shoulder replacement may be candidates for the reverse procedure.

A reverse is for patients who have bad arthritis with no rotator cuffs, patients who have rotator cuffs we can no longer repair, or patients who unfortunately break their shoulders and cannot be put back together with plates and screws, Dr. Campbell says.

People with severe rotator cuff damage or a fractured shoulder still may not be able to move their shoulder normally after a typical total shoulder replacement. A reverse total shoulder procedure works better for these people because it relies on different muscles to move the arm afterward.

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What Causes The Conditions Treated By Shoulder Replacement Surgery

There are two basic types of arthritis that affect the shoulder.

  • : This is physical wear and tear on the cartilage inside the joint that develops from years of use. Although many older adults experience OA at some point, they are more likely to get it in their knees, hips or fingers than the shoulder. Osteoarthritis in the shoulder is more common in exceptionally active people , such as tennis players, weightlifters and other athletes who put continual pressure on their shoulders. In some cases, a severe, acute injury triggers or contributes to this long-term damage, for example:
  • Purpose Of Total Shoulder Replacement Surgery

    Reverse Shoulder Replacement Risks and Complications

    Patients with frequent shoulder pain or limited mobility of the shoulder can have a variety of conditions or issues that would lead a surgeon to recommend a total shoulder replacement. The surgery helps restore the function of the shoulder by providing stability and increased range of motion. People with shoulder pain may reach a point where conservative therapy no longer helps with their pain or range of motion.

    The following conditions are examples of causes for shoulder pain that could require surgery:

    • Osteoarthritis: In this condition, the joint gets worn out from use, and cartilage can be worn away, leaving the ends of the bones exposed without cushioning. This causes pain as the shoulder moves.
    • Rheumatoid arthritis: Chronically inflamed tissues of the joint could lead to damage of the cartilage, creating pain and instability.
    • Severe fractures: People who experience shoulder trauma and have weakened bones are more likely to have a serious fracture of the bones in the shoulder that could potentially impact blood supply or stability of the joint.
    • Avascular necrosis: Decreased blood supply to the bone causes the cells of the bone to die and could potentially lead to arthritis. This can occur due to sickle cell disease, chronic steroid use, excess alcohol consumption, and deep sea diving.

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    Recovering From A Shoulder Replacement Surgery And What To Expect

    A shoulder replacement can help restore function and decrease pain in your damaged shoulder joint. While minimally invasive surgical techniques can shorten the recovery time, there still is a period of convalescence. If you are recommended to have your shoulder replaced, be sure to discuss what to expect during and after surgery with your orthopedic surgeon.

    Lets explore the common challenges that patients experience after shoulder replacement.

    Stretching Of The Brachial Plexus

    The arm is lengthened by 15mm to 27mm after reverse total shoulder arthroplasty.48 Nerve monitoring during shoulder arthroplasties has shown more nerve alerts during RSA than during anatomical total shoulder arthroplasty.49 Lenoir et al.50 found that the axillary and radial nerves were often stretched during the procedure. The author has seen several cases of postoperative numbness in the hand, particularly in the ulnar nerve area. However, it is unclear whether this can cause postoperative pain in the shoulder and arm. Further research is needed.

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