ment patterns in ADLs before surgery that could not be reversed because the patients were not sufficiently trained to use the new ROM. The conclusion of this study was that TSA does improve ROM in performing ADLs in patients with degenerative glenohu- meral osteoarthritis. TSA patients did not use their maximal avail- able abduction ROM when performing ADLs, which may not be related to limitations in active ROM but may be caused by patho- logic motion patterns, impaired proprioception, or both factors. Patients who have a primary rTSA have shown a significant in- crease in active shoulder elevation postsurgery. Patients typically regain in excess of 105 degrees of active shoulder elevation. The results are superior to those of hemiarthroplasty for rotator cuff arthropathy. Active shoulder rotation in those with cuff deficiency has not been reported to improve following rTSA. Patients with teres minor deficiency have markedly limited active external rota- tion following rTSA.
years postsurgery. This may not be related to range of motion limitations in active abduction but may be caused by impaired proprioception. Proprioception in another study was shown to de - teriorate following TSA. This may be because of the deltopectoral approach that includes division of the subscapularis muscle and the glenohumeral ligament that may cause alterations in move- ment patterns. Another explanation of impaired use of available ROM is that patients with osteoarthritis may have developed impaired move - Conclusion Shoulder arthroplasty is the treatment of choice for severe degen- erative joint disease. Total shoulder replacement has been shown to provide excellent clinical outcomes with good durability. These results have been shown to be superior to hemiarthroplasty. TSA can improve functional range of motion with good long-term pain relief. Surgeons with higher volumes of performing shoulder replacements have better patient outcomes with fewer compli- cations. When TSA is performed under the appropriate clinical indications, complete pain relief and normal or near-normal resto- ration of function is often the result. References Bohsali, K. I., Wirth, M. A., & Rockwood Jr., C. A. (2006). Complications of total shoulder arthro plasty. The Journal of Bone and Joint Surgery, Incorporated, 88-A, 10. Boudreau, S., Boudreau, E., Higgins, L. D., & Wilcox III, R. B. (2007). Rehabilitation following reverse total shoulder arthroplasty. Journal of Orthopaedic & Sports Physical Therapy, 37(12). 734–743. Guo, J. J., et al. (2016). Three-year follow-up of conservative treatments of shoulder arthritis in older patients. Orthopedics, 39(4), e634–e641. Magermans DJ, Chadwick EK, Veeger HE, & Van der Helm FC. Requirements for upper extremity motions during activities of daily living. Clin Biomech (Bristol, Avon) 2005:20:591-599. Maier, M. W., et al. (2014). Motion patterns in activities of daily living: 3-year longitudinal follow-up after total shoulder arthroplasty using an optical 3D motion analysis system. BMC Musculoskeletal Disorders, 15, 244.
Millett, P. J., Gobezie, R., & Boykin, R. E. (2008). Shoulder osteoarthritis: Diagnosis and management. American Family Physician, 78(5), 605–611, 612. Ryan P, Dachs RP, du Plessis JP, Vrettos B &, Roche S. Reverse total shoulder arthroplasty for complex proximal humerus fractures in the elderly: how to improve outcomes and avoid complications. SA Orthopaedic Journal. 2015;14(1): 25-33. Speer KP, Warren RF, & Horowitz L. The efficacy of cryotherapy in the postoperative shoulder. J Shoulder Elbow Surg. 1996;5:62-68. Wilcox III, R. B., Arslanian, L. E., & Millett, P. J. (2005). Rehabilitation following total shoulder arthroplasty. Journal of Orthopaedic & Spo rts Physical Therapy, 35(12), 821–836.
TOTAL SHOULDER ARTHROSCOPY AND REVERSE TOTAL ARTHROSCOPY: WHAT PHYSICAL THERAPISTS NEED TO KNOW Final Examination Questions Select the best answer for each question and mark your answers on the Final Examination Answer Sheet found on page 203, or complete your test online at EliteLearning.com/Book 148. Risk factors for shoulder OA include all of the following
153. Following a TSA procedure, a patient should generally wear a sling for: a. 3 to 4 weeks. b. 6 weeks. c. 8 weeks. d. 10 weeks. 154. Postsurgery Day 1 following a TSA passive IR can be performed to: a. 30 degrees. b. 15 degrees. c. To chest. d. 60 degrees. 155. Criteria to progress from Phase I to Phase II of the TSA postoperative protocol includes: a. Achieves at least 100 degrees PROM flexion. b. Achieves at least 60 degrees PROM ER in plane of scapula. c. Achieves at least 90 degrees of PROM abduction. d. Achieves at least 45 degrees PROM IR in plane of scapula. 156. Criteria to progress from Phase II to Phase III of the TSA postoperative protocol includes: a. Achieves at least 160 degrees PROM flexion. b. Achieves at least 100 degrees PROM abduction. c. Achieves at least 70 degrees ER in plane of scapula. d. Achieves at least 70 degrees IR in plane of scapula measured at 30 degrees of abduction. 157. Precautions in Phase III of the TSA include all of the following EXCEPT: a. No heavy lifting. b. No sudden lifting or pulling activities. c. No reaching overhead. d. No sudden jerking motions.
EXCEPT: a. Age. b. Sex.
c. Height. d. Weight.
149. Pain that is not induced by joint palpation or passive range of motion would be more suggestive of all of the following EXCEPT: a. Rotator cuff disease. b. Osteoarthritis. c. Biceps tendinitis. d. Bursitis. 150. Morning stiffness of the shoulder joint likely indicates which of the following conditions? a. Rheumatoid arthritis. b. Osteoarthritis. c. Bursitis. d. Rotator cuff tear. 151. Joint preservation surgery is preferable for patients younger than _____________ years or those with early stage degenerative joint disease of the shoulder. a. 40 to 50. b. 55 to 60. c. 65 to 70. d. 70 to 80. 152. According to one study by Wilcox III and colleagues (2005), the average forward flexion achieved following TSA in the group with OA was _______ degrees.
a. 170. b. 113. c. 148. d. 120.
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