What is Total Shoulder Arthroplasty?
Total shoulder arthroplasty (TSA) is a surgical procedure in which part or all of the shoulder joint is replaced. It is performed on the shoulder when medical interventions, such as other conservative surgeries, medication, and physical therapy, no longer provide pain relief. The decision to have a TSA is made following consultation with your orthopedic surgeon and your physical therapist.
A shoulder replacement may be needed if you have any of the following conditions affecting the shoulder, causing severe shoulder pain and limiting your ability to use the affected shoulder:
- Osteoarthritis
- Rheumatoid arthritis
- Severe shoulder fracture
- Rotator cuff disease (a muscle tear or soft-tissue breakdown of the rotator cuff)
- Osteonecrosis of the shoulder (death of the bone tissue at the head of the humerus)
A TSA involves removing the ends of the bone at the shoulder joint, and replacing them with artificial parts.
The upper part of the arm bone (humerus) is shaped like a ball, which is called the “head” of the humerus. During a TSA, the head of the humerus is replaced by a metal ball. The socket is where the head of the humerus sits and is called the glenoid fossa. During a TSA, the socket is replaced by a plastic cup.
Due to various physical limitations, your orthopedic surgeon may decide that you are a candidate for another form of TSA, such as:
Shoulder hemiarthroplasty, where only the head of the humerus is replaced with a metal ball.
Another form of replacement is the reverse total shoulder arthroplasty (This procedure is recommended when the rotator cuff muscles of the shoulder are damaged. The plastic socket is attached to the top of the humerus, and the metal ball is connected to the socket. This procedure allows another shoulder muscle, called the deltoid, to take over for the damaged rotator cuff muscles. This will allow for an improved functional range of motion, strength, and stability of the shoulder without the need for the rotator cuff.
How Can Physical Therapy Help?
Physical therapy is vital in ensuring a safe recovery by improving shoulder function and limiting pain following a TSA. Your physical therapist will work with you before and following your surgery to help you safely return to your previous levels of activity, including performing household chores, job duties, and recreational activities.
Before Surgery
The better physical condition your shoulder is in before surgery, the better your recovery will be. Your physical therapist will teach you exercises to build shoulder strength and improve your shoulder and upper back movement. This will help to keep the shoulder as strong and mobile as possible up until the time of surgery.
After Surgery
Your physical therapist will educate you about various precautions after surgery, such as wearing a sling to perform all activities and how to safely begin moving your arm. If you are a smoker, quitting smoking will improve your healing process.
After your TSA, you will likely stay in the hospital for 2 to 3 days. If you have other medical conditions, such as diabetes or heart disease, your hospital stay may be a few days longer. Your shoulder will be placed in a sling for the next 2 to 6 weeks; you will be advised not to move your shoulder on your own.
Your physical therapy will begin within a day or two after your surgery. A hospital physical therapist will visit your room to teach you how to perform simple tasks like brushing your teeth and tell you what movements (such as pushing, pulling, or reaching with the affected arm) you simply cannot perform. Your physical therapist will teach you how to; get in and out of bed safely, get the sling on and off, and get dressed while keeping your shoulder in a safe position. You will also learn how to minimize pain and swelling in the area by applying an ice pack and elevating the upper arm.
You may need help from friends or family members with daily activities for the first few days or weeks after your surgery. You will not be able to drive for the first few weeks after surgery.
As You Recover
When you are discharged from the hospital, continuation of physical therapy is essential. Your surgeon and physical therapist will work as a team to ensure your safe recovery. Your physical therapist will teach you exercises that may include:
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