The Total Shoulder Replacement (TSA) is the least common joint replacement surgery I see in the clinic (other than ankle replacement, I will not do a post on this because I have never treated it).
The shoulder replacement is also newer to the surgery game. But has become frequently performed in the last few years.
I see it mainly in 2 different types of people: those is osteoarthritis in the shoulder or those that have severe fractures to shoulder.
There are other reasons for needing a TSA
- Osteoarthritis
- Shoulder Fractures
- Rotator cuff injuries
- Rheumatoid Arthritis
- Avascular Necrosis
There are also 2 types of TSA
Regular: where the ball and socket joint is the same as a natural shoulder
Reverse: where the ball and socket are switched
When I spoke with one Orthopedic Surgeon, he states that he would perform a regular TSA if the patient had Osteoarthritis, but he would do a reverse if the patient had a fracture or rotator cuff injuries. If you would like to learn more about the surgery check out the research here.
Week 1-6 Exercises
During this time, passive range of motion, gentle isometrics, and Codman exercises will be the only activities to perform. Check out this blog post here I did about isometrics to learn more.
- Codman’s Pendulums
- Shrugs
- Scapular squeezes
Usually, passive range of motion is the performed about 30 minutes with the other activities only taking about 10 minutes.
Week 6-12 Exercises
During this time, the most important goal is to improve range of motion. Most activities will be active assisted and active range of motion exercises. Very light strengthening, mostly against gravity and not more than 5 pounds of resistance is performed.
Active-assistive and active range of motion activities including:
- Pulleys
- Table slides
- Wall slides
- Supine and standing wand activities in all directions
- 3 way raises
Week 12 and beyond exercises
During this time, strengthening activities will begin. Starting slow with resistance and building up to heavier weight.
- Bicep curls
- Tricep Extensions
- 6 way shoulder activities
- over head presses
- chest press
- UBE
The list could go on for strengthening exercises.
Something else to be aware of at this point, is to focus on what the patient wants to be able to achieve. If there is an activity the patient is still having trouble with, perform exercises or activities that would help them reach that goal.
Achieving Full Range of Motion Following TSA
Lastly, with either of these surgeries, reaching the full range of motion of the shoulder may not be possible for everyone. Not to say it will not happen with someone. I have never seen someone get to that motion myself.
I have seen every person I have treated achieve functional motion. Meaning, they can do everything they want without limits.
Even though the Total Shoulder Replacement is the least common joint replacement surgery I see in the clinic, it is still important to know the protocol to help patients properly.