Chapter 12: Total Shoulder Arthroscopy and Reverse Total Arthroscopy: What Physical Therapists Need to Know 2 CC Hours
By: Lisa Augustyn, PT, DPT Learning objectives
State the components of a typical physical therapy rehabilitation plan following a total shoulder replacement and reverse total shoulder replacement. Describe complications related to total shoulder replacement and reverse total shoulder replacement surgeries. Describe surgical outcomes of total shoulder replacement and reverse total shoulder replacement.
Describe the path toward having a total shoulder replacement/arthroplasty or a reverse total shoulder replacement/arthroplasty. Be able to describe the signs and symptoms associated with shoulder osteoarthritis and treatment strategies for shoulder osteoarthritis. Describe an overview of surgical procedure of both the total shoulder replacement and reverse total shoulder replacement. Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gen- der identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can mani- fest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assump- tions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing implicit bias in
healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and aware- ness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Addi- tionally, implementing policies and procedures prioritizing equi- table treatment for all patients can play a pivotal role in reduc- ing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treat- ment regardless of their background or characteristics.
INTRODUCTION
joint arthroplasties. The reverse TSA (rTSA) is also used in cases where the traditional TSA cannot be utilized. It is important to understand the surgical procedures for the TSA and rTSA as well as understand the rehabilitation protocols. It is also important for physical therapists to understand complications that may occur following these types of surgical procedures.
Since the development of the Neer prosthesis in the 1950s, shoul- der arthroplasty has advanced considerably. The total shoulder arthroplasty (TSA) can significantly improve function in patients with shoulder osteoarthritis (OA). But a patient may still have diffi- culty performing activities of daily living (ADLs). More patients are becoming candidates for TSA. There has been an increase in the number of these procedures similar to the increase in other total
PATH TO TSA AND REVERSE TSA: HOW A PATIENT GETS TO THIS POINT?
plex three-part and four-part displaced fractures are more likely to require surgical intervention. Management of a proximal humeral fracture depends on multiple patient factors, including advanced aging, increased number and severity of comorbidities, pre-existing rotator cuff abnormalities, osteoporosis, and the ability to engage in postoperative rehabili- tation. There is debate and conflicting literature regarding the optimal management of this difficult group, including whether it should be operative or nonoperative management and, if opera- tive management, which type of surgery should be performed. There is a lower surgical rate in older patients because of the per- ceived poor outcomes of TSA, the lack of emphasis by patients and providers about the importance of having a functional shoul- der, and the cost of surgery. For active patients, urgent lifting re- quirements can cause more stress on the shoulder arthroplasty, and the implant can fail. Patients may need a TSA or rTSA because of such conditions as shoulder OA, rheumatoid arthritis, rotator cuff deficiency, cuff tear arthropathy, osteonecrosis, and proximal humerus fracture pathol- ogy. TSA has been found to be the most successful intervention for pain relief and restoration of function in patients with severe shoulder OA (Wilcox III, Arslanian, & Millett, 2005).
Shoulder OA is characterized by a narrowing of the glenohumeral joint. Patients with this condition typically present with shoulder pain, limitations of shoulder function, and upper extremity dis- ability. Patients with shoulder OA typically complain of chronic shoulder pain with an insidious onset. Other complaints include shoulder stiffness, pain in the morning, and increased symptoms with weather changes. Pain also generally increases with activity, and patients may complain of a specific injury that exacerbated the pain and stiffness. When nonoperative treatment of shoulder arthritis fails to de - crease pain or improve function, or when there is severe wear and tear of the joint causing parts to loosen and move out of place, shoulder arthroplasty becomes the ultimate treatment that may provide the best results. Shoulder arthroplasty has become an acceptable treatment option for many painful and degenerative conditions of the shoulder. Over the past 5 to 10 years, reverse total shoulder arthroplasty has gained in popularity for managing complex proximal humerus fractures. Proximal humerus fractures account for about 5% of all humeral fractures (Ryan et al.) Females are affected twice as fre- quently as males are, and with advancing age, the severity of the fracture is increased. Simple, minimally, or nondisplaced fractures can be managed successfully without surgery, but the more com-
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Book Code: PTCA2624
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