As a general rule, joint replacement surgery is intended to reduce pain and improve function of a joint. The standard shoulder replacement surgery involves replacing the head of the humerus (upper arm) with a polished ball and stem which then moves inside a plastic socket that is fixed at the top of the shoulder. This procedure is performed successfully on thousands of patients a year to treat severe arthritis. For a subset of patients, however, the reverse total shoulder replacement is a better option. Unlike a standard shoulder replacement surgery wherein the anatomy of the joint is maintained, in a reverse total shoulder the socket and ball are reversed. The plastic socket attaches to the head of the humerus and then rotates around the ball which is fixed at the top of the shoulder.

While treatment of severe osteoarthritis, traumatic arthritis, osteonecrosis and unhealed or unstable fractures is an indication for shoulder replacement, those with large rotator cuff tears who have developed a type of arthritis called cuff-tear arthropathy, usually do better with a reverse total shoulder than a standard shoulder replacement. This is because the reversal of anatomy allows the patient to rely on healthy and intact muscles instead of the torn muscles, to move the arm.

WHY CHOOSE PREHABILITATION BEFORE REVERSE TOTAL SHOULDER REPLACEMENT SURGERY?

If you decide to work with a physical therapist to help with physical therapy for after shoulder arthroplasty surgery, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

WHAT CAN YOU EXPECT FROM REVERSE TOTAL SHOULDER SURGERY PREHAB?

My team of therapists will individualize a prehabilitation program just for you, however, there are many elements that are common across different prehabilitation programs. To help you gain a better understanding of what to expect, here is a list of some common goals of reverse total shoulder arthroplasty prehab:

Set expectations: The idea of surgery can be intimidating. Having an idea of what to expect after the procedure can ease some of your anxiety and help ensure you have what you need to support your recovery. Getting to know your physical therapist before surgery will help build trust with them when it comes time for post-operative care. They can advise you on any movement precautions you may have after surgery and any equipment or modifications to your home that might be necessary. They can also help you understand what kind of help or support you will need from others and prepare you for how your body may feel after surgery.

Manage pain and inflammation: Pain and inflammation are natural side effects of chronic joint damage. They alert us that we need to protect the injured area and that the body is trying to heal itself. Chronic pain and inflammation can benefit from physical therapy to help reduce the pain response prior to surgery, especially if surgery is delayed for any reason. Learning strategies to manage pain and inflammation will help you stay comfortable and as active as possible in preparation for surgery.

Build or maintain strength and flexibility: While the brain knows that surgery is intended to “heal” the injury, the body views the surgical procedure as another injury to the tissues. While the surgeon has replaced the shoulder joint, which will ultimately improve your symptoms and improve use of the arm, the body will need to heal from the effects of the surgery before that can happen. Maximizing strength, soft tissue mobility and flexibility prior to the surgery can help decrease muscle atrophy and stiffness following the procedure which can ultimately quicken your recovery.

Prehabilitation for shoulder replacement surgeries is an excellent choice for those wanting to get a head start on their recovery and to help improve their chances of a good surgical outcome. My team of therapists and I would love to help you prepare for your upcoming reverse total shoulder replacement surgery. Call the office at Evolve today to get started.