Many of our patients are unsure if a total shoulder replacement or reverse shoulder replacement is best for them. This article helps you learn the difference between these 2 common shoulder surgeries.
A reverse replacement involves changing, or “reversing”, the position of the ball and socket so that the ball is on the socket side of the joint and the socket is on the ball side. A total shoulder replacement keeps the normal ball and socket arrangement.
In the normal shoulder, your rotator cuff muscles help the large deltoid muscle raise your arm. When your rotator cuff is torn and non-functional, your humeral head (arm bone) “escapes” upwards within the joint. Your deltoid is then unable to lift your arm by itself.
By reversing the ball and socket, the loss of your rotator cuff is compensated for. And your deltoid muscle can once again raise your arm.
Who Benefits from Reverse Shoulder Replacement Surgery?
A reverse shoulder replacement has been performed for over 30 years in Europe but has only been FDA-approved in the United States since 2003. In 2011 approximately 1/3 of shoulder replacement procedures were reversed. Approximately 80% of patients who undergo it do so because of arthritis and rotator cuff deficiency.
Another common and increasing indication is complex fractures of the upper part of the arm bone, accounting for about 10% of reverse shoulder replacements. Other indications include rheumatoid arthritis and revision of a total shoulder replacement.
Physical Therapy After a Reverse Shoulder Replacement
Physical therapy following reverse shoulder arthroplasty is based on 3 important considerations:
- Protecting the healing joint
- Maximizing deltoid muscle function
- Establishing appropriate functional and range of motion expectations
Rehab during the first 4 weeks following your surgery focuses on joint protection strategies (including sling use), pain control, and gradual restoration of range of motion. Joint protection is important to minimize the risk of complications following your surgery. Shoulder dislocation is one such complication that requires care during the early phases of recovery. Movements such as reaching behind your back should be avoided or minimized due to the vulnerability of the shoulder to dislocate in this position. Performing range of motion home exercises is very important to achieve your best results.
By the 6th postoperative week, gentle deltoid and shoulder blade muscle strengthening exercises are initiated. These exercises are important to regain functional use of your arm for activities of daily living (dressing, bathing, etc) and light athletic activities (tennis, swimming, etc).
A normal full active range of motion following surgery is not expected in most cases. However, we have witnessed some very impressive results where individuals have recovered to the same extent, or better, than their uninvolved shoulder.
See Your Physical Therapist For Help After Surgery
From our experience and the latest research, recovery of functional range of motion is dependent on your pre-surgery status, the extent of rotator cuff damage, and adherence to your home exercise program. If you are considering undergoing a reverse shoulder replacement, or have recently undergone this procedure, please call one of our physical therapists to learn more about your recovery and return to function.
