Total shoulder Arthroplasty (Full Version)

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Kaden -> Total shoulder Arthroplasty (June 19, 2007 9:15:00 AM)

I was wondering for those who see TSA when they typically implement IR with resistance. Most MD's in my region wait 12 weeks but doesn't seem practical as the patient is usually not in my care at that time.



PTupdate.com -> Re: Total shoulder Arthroplasty (June 21, 2007 4:52:00 PM)

You're right...patients are often out of benefits when they can finally do something. But, tissue healing is tissue healing, and pushing IR too much too quick may not be worth the risk. Considering the pecs and lats are the primary internal rotators, that subscap function will be compensated for until it reaches it's own potential. If you are discharging a person, just tell them, and teach them how to work on IR strengthening down the road.

John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]



buckeye -> Re: Total shoulder Arthroplasty (June 22, 2007 7:07:00 AM)

Waiting the 12 weeks is often necessary for the soft tissue healing as PTupdate notes.
Another alternative is discussing with the surgeon and patient the importance of further PT for instruction/practice in appropriate exercises with the proper timing for healing. If insurance benefits are a concern, this may mean fewer visits early in the rehab program and increased patient responsibility for the early phase(s) of rehab.



Kaden -> Re: Total shoulder Arthroplasty (June 22, 2007 3:03:00 PM)

thanks for the info. I will wait the 12 weeks or instruct patient to implement at home as this is what the physician would like.

I was just wondering what timelines others are seeing as I see 6 and 8 weeks as timelines in the literature to begin resisted IR as well.



buckeye -> RE: Re: Total shoulder Arthroplasty (July 3, 2007 9:50:19 AM)

You are right, the information available is variable for directions about starting resistive exercise.

I do not see many TSAs - the directions from surgeons have varied from 8 to 12 weeks. I tend to be conservative and look at 8 weeks as the standard for active and 12 weeks for resistive exercises with most muscle repairs. I push to get motion as early as allowed by the procedure but feel the virtue of patience is valuable in getting the strength to return.
It may be possible to gain some gentle but effective early strengthening/muscle reeducation with gentle UE weight bearing. I usually ask the surgeon how soon the patient can lean on the arm - but not bear all of body weight. The weight bearing likely promotes more scapular stabilizer activity.



Tom Reeves DPT ATC -> RE: Total shoulder Arthroplasty (July 16, 2007 2:58:22 PM)

treat it like a nasty nasty shoulder dislocation.  One way to preserve the benefits is to create a home ex program and follow up with them less frequently, only to re-assess and progress rather than observe.  I find that many PTs waste too many visits watching the patient do their home ex program rather than letting them do it at home.




Sebastian Asselbergs -> RE: Total shoulder Arthroplasty (July 16, 2007 6:46:08 PM)

I fully agree, Tom.



USAPT -> RE: Total shoulder Arthroplasty (July 17, 2007 10:07:14 AM)

I second that Sebastian. Kaden, I have a TSA pt now and at 6-8 weeks we can begin isometrics (varying angles)with emphasis on subscapularis (IR/add) and progress as tolerated next several weeks. Full motion by 8 weeks, per protocol. I have yet to have a pt full ROM anyway and don't really expect them to. Other than STM and gentle stretching, observe their HEP for technique but no need to 'watch' them perform it and charge for it.

I'm new to this area and this is what the PA-C gave me for a protocol.

Good luck
-Jason



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