The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation for anatomic total shoulder arthroplasty

Abstract

Anatomic total shoulder arthroplasty is the gold standard shoulder replacement procedure for patients with an intact rotator cuff and sufficient glenoid bone to accommodate prosthetic glenoid implant and offers reliable patient satisfaction, excellent implant longevity, and a low incidence of complications. Disparity exists in the literature regarding rehabilitation strategies following anatomic total shoulder arthroplasty. This article presents a consensus statement from experts in the field on rehabilitation following anatomic total shoulder arthroplasty. The goal of this consensus statement is to provide a current evidence-based foundation to inform the rehabilitation process after anatomic total shoulder arthroplasty. These guidelines apply to anatomic total shoulder arthroplasty (replacement of the humeral head and glenoid), hemiarthroplasty (replacing only the humeral head), and hemiarthroplasty with glenoid reaming or resurfacing. The consensus statement integrates an extensive literature review, as well as survey results of the practice patterns of members of the American Society of Shoulder and Elbow Therapists and the American Shoulder and Elbow Surgeons. Three stages of recovery are proposed, which initially protect and then gradually load soft tissue affected by the surgical procedure, such as the subscapularis, for optimal patient outcomes. The proposed guidelines should be used in collaboration with surgeon preferences and patient-specific factors.

Keywords: Shoulder arthroplasty; exercise; physical therapy; rehabilitation; shoulder replacement; subscapularis.

Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Three methods of subscapularis takedown: (A) lesser tuberosity osteotomy, (B) subscapularis peel, and (C) subscapularis tenotomy. (Dunn et al, reprinted with permission)

Figure 2

Sling with abduction pillow.

Figure 3

Passive methods for external rotation to 30° in phase 1 of rehabilitation: (A) assisted with the well arm and (B) by supported step-around.

Figure 4

Passive elevation with (A) table slide and (B) table step back.

Figure 5

Elevation progression: Patient progresses from the “balanced position” of holding the weight of the arm at 90° in supine, through progressive arcs of active range of motion in supine, then inclined, then upright. On each progression, the elbow is initially bent for a short lever arm, and then straightened for a long lever arm load.