Total Shoulder Arthroplasty (TSA)

Shoulder injuries are common among workers with job roles that are physically demanding and/or require repetitive use of the upper limb, particularly overhead.  Injuries range from shoulder bursitis and muscular strains, to multiple tendon tears with varying degrees of joint degeneration.  A total shoulder arthroplasty (TSA; arthroplasty is the surgical reconstruction or replacement of a joint) is used to treat advanced arthritic conditions when non-operative therapies have failed and pain levels and functional restrictions are interfering with both sleep and activities of daily living.  It is vital the non-operative therapies such as exercise rehabilitation and anti-inflammatory medications are afforded ample time to enable their benefits to take effect prior to proceeding with a TSA.  The exercise modalities also provide a valuable source of pre-habilitation to enhance the recovery outcomes post-surgery.

The shoulder joint (AKA: glenohumeral joint) is the most mobile joint in the body – think about all the movements you perform with your arm from washing your hair, to swimming and throwing a ball.  This ball and socket joint is comprised of the head of the humerus (ball) and the glenoid (socket) of the scapula.  Due to the high degree of movement that is capable occur at the shoulder, there are several key muscles and ligaments which provide stability to reduce the risk of injury.  Four of these muscles are collectively known as the rotator cuff, which consists of the subscapularis, infraspinatus, supraspinatus, and teres minor.  These muscles work together to ensure the head of the humerus remains centred within the glenoid and contribute to movements of the shoulder including rotation, extension, and abduction.

During a TSA, the degenerative ball and socket joint is replaced with polyethylene and metal components, mimicking the normal structure of the joint.  The long-term outcome post-surgery is dependent on several factors, one of these being exercise rehabilitation.  The rehabilitation will be individualised and focus on progressively improving shoulder range of motion, muscle activation patterns and restoring strength and endurance of the upper limb musculature.  The programme will focus on restoring scapular control and rotator cuff function to improve enhance the recovery process.  At Absolute Balance we establish specific goals based on the patient’s critical physical demands at home and work to facilitate a progressive return to pre-injury activities, in consultation with the treating specialists.  These goals help provide direction and an individualised approach to help achieve a positive outcome for the patient.

If you would like more information on shoulder injuries or other rehabilitation programmes that Absolute Balance can provide, please don’t hesitate to contact us at info@absolutebalance.com.au

Daniel D’Avoine

BSc(ExerSc&Rehab) – AEP

Workers Compensation Specialist

 

References:

Boileau, P. (2016). Complications and revision of reverse total shoulder arthroplasty. Orthopaedics & Traumatology: surgery & research, 102(1), S33-S43.

Kiet, T.K., Feeley, B.T., Naimark, M., Gajiu, T., Hall, S.L., Chung, T.T., & Ma, C.B. (2015). Outcomes after shoulder replacement: comparison between reverse and anatomic total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery, 24, 179-185.

Schwartz, B.E., Savin, D.D., Youderian, A.R., Mossad, D., & Goldberg, B.A. (2015). National trends and perioperative outcomes in primary and revision total shoulder arthroplasty. International Orthopaedics, 39, 271-276.

Simovitch, R., Flurin, P.H., Wright, T., Zuckerman, J.D., & Roche, C.P. (2018). Quantifying success after total shoulder arthroplasty: the minimal clinically important difference. Journal of Shoulder and Elbow Surgery, 27, 298-305.