Total Shoulder Replacement

Question 1

indications for TSJR

Answer 1

∗ Hard to control pain, particularly if affecting sleep/ADLS
∗ Glenoid cartilage degeneration
∗ Preferred over hemi for OA/inflammatory arthritis
∗ Posterior humeral head subluxation

Question 2

contraindications

Answer 2

Insufficient glenoid bone stock
Rotator cuff arthropathy
Deltoid dysfunction
Irreparable rotator cuff
Active infection
Brachial plexus palsy

Question 3

indications for reverse TSJR

Answer 3

∗ CTA (cuff tear arthropathy) ∗ Rotator cuff insufficiency
∗ Pseudoparalysis
∗ Antero-superior escape
∗ 3/4pt fractures
∗ Failed arthroplasty ∗ RA

Question 4

reverse TSJR are appropriate for

Answer 4

∗ Low functional demand
∗ >70yr of age
∗ Must have sufficient glenoid bone stock ∗ Must have a working deltoid muscle
∗ Must have an intact axillary nerve

Question 5

TSJR physio

Answer 5

Chest Physio, circulation exercises
Mobilize out of bed day 1
Ice
Shoulder Immobiliser sling until Week 6
No WB through shoulder, no lifting
Exercises: elbow, wrist, hand + grip, c-spine
PROM: flexion to 90, external rotation to 0

Question 6

tsjr physio2

Answer 6

∗ Passive or active-assisted motion only during early rehab
∗ limiting factor in early rehab is risk of injury to the subscapularis tendon repair
∗ pendulum exercises, scapula setting/positioning
∗ Progress to ER isometrics
∗ Limit passive external rotation
∗ risk of tear and pull-off of subscapularis tendon from
anterior humerus
∗ tear leads to anterior shoulder instability (most common form of instability after TSA)
∗ IR eccentric and isometric

Question 7

safe D/C guidelines for all patients

Answer 7

Adequate support and assistance in place
Equipment required at home Walking aid issued
Mobilizing independently
Safe on stairs
Joint range aim achieved
Obs stable, wound healing, no infection Catheter out
Pain managed appropriately