This presentation will cover common causes of glenohumeral osteoarthritis and the role of the physical therapist in non-operative management. Instruction will continue to include surgical anatomic shoulder arthroplasty with the two different methods of accessing the glenohumeral joint and post-operative rehabilitation considerations for each approach. Post-operative management of reverse shoulder arthroplasty will also be discussed briefly, with consideration to the various indications as they related to varied outcomes.
Level of Instruction: Intermediate
- Describe the progression of glenohumeral osteoarthritis and the change in management strategies over time.
- Develop and implement a rehabilitation plan for the population that have total shoulder arthroplasty, with knowledge of precautions and end result expectations.
- Understand the different methods of surgically accessing the glenohumeral joint for anatomic shoulder arthroplasty and the implications this has on post-operative rehabilitation.
- Describe the process of cuff tear arthropathy that can occur with chronic massive rotator cuff tears, and the management of this challenge with reverse shoulder arthroplasty. Develop a post-operative rehabilitation program including precautions and expectations for this population.
- Glenohumeral joint degeneration normally occurs with posterior glenoid erosion, and one possible cause may be related to instability – both multidirectional, and unidirectional with and without history of stabilization procedures.
- Attempts to minimize further glenohumeral joint erosion should be directed at keeping congruent centers of rotation between the humeral head and glenoid fossa, while minimizing joint compression forces. Mobilization strategies and exercise selections should be selected with these considerations guiding treatment interventions.
- When glenohumeral joint osteoarthritis advances to a level of patient disability due to pain and loss of mobility, anatomic total shoulder arthroplasty may be performed. Access to the glenohumeral joint mandates mobilization of the subscapularis muscle, and this mobilization can be done with a soft tissue peel or boney osteotomy of the lesser tuberosity.
- The surgical procedure used to mobilize the subscapularis should dictate rehabilitation progression after anatomic total shoulder arthroplasty. Failure to heal the subscapularis repair can jeopardize shoulder function dramatically.
- A special case of shoulder osteoarthritis is called cuff tear arthropathy. This condition occurs when there is a massive rotator cuff tear and the humeral head articulates with the acromion process. The management of this condition surgically may be a reverse shoulder arthroplasty which has unique rehabilitation considerations that will be briefly discussed.
- June Kennedy PT, MSPT
June Kennedy, MS,PT is a senior level physical therapist at Duke Sports Medicine Physical Therapy with over 25 years of clinical experience. She specializes in surgical and non-operative care of shoulder patients and is an active member of the American Society of Shoulder and Elbow Therapists, also serving on the research committee of this organization. She reviews rehabilitation based articles for the Journal of Shoulder and Elbow Surgery and lectures to the Duke surgery fellows annually on shoulder rehabilitation for adhesive capsulitis, shoulder instability, and total and reverse shoulder arthroplasty. Additionally June has served on the Review Panel for the American Academy of Orthopedic Surgeons for the development of Appropriate Utilization Criteria for surgical intervention on rotator cuff tears.
Contact Hours: 1.5