image showing shoulder replacement on an x-ray

Having a shoulder replacement, like any joint replacement, is not a decision to be taken lightly.

Replacing a joint, while it may sound like an easy solution to a pain-point, is an extensive surgical procedure that requires significant recovery time.

This is not to say that joint replacements aren’t necessary- they can be and they can be very successful.

However, it’s important to know the types of shoulder replacement, why one may be recommended to you, and what to expect during recovery. This article will explore all of those topics.

Understanding Shoulder Replacement Surgery

older adult experiencing shoulder pain

Shoulder replacement surgeries, both traditional and reverse, are interventions for older adults experiencing severe shoulder pain and mobility issues, typically due to conditions like severe osteoarthritis, rotator cuff tear, fracture, rheumatoid arthritis, or osteonecrosis (where blood flow to the humerus is impaired; AAOS, n.d., Mayo Clinic, n.d.).

Why Shoulder Replacement?

In older adults, the need for shoulder replacement arises due to the degeneration of the shoulder joint, often exacerbated by age-related conditions like arthritis or severe injuries (AAOS, n.d.).

Types of Shoulder Replacements

X-ray showing a partial shoulder replacement

There are three different types of shoulder replacement and the reasons behind one being recommended over another typically depend on the reason the replacement is needed (arthritis versus injury, for example), the patient’s overall health, age, as well as the surgeon’s preference.

  1. Traditional (Total) Shoulder Replacement: This procedure involves replacing the damaged joint surfaces with a metal ball and a plastic socket. It’s usually recommended for patients with intact rotator cuff tendons and severe arthritis (AAOS, n.d.).
  2. Reverse Shoulder Replacement: Here, the ball-and-socket structure of the shoulder joint is reversed, which is beneficial for those with a completely torn rotator cuff or previous unsuccessful shoulder surgeries (Mayo Clinic, n.d.).
  3. Partial Shoulder Replacement: This is when just the ball (head of the humerus) is replaced. This would likely be recommended for those who only have damage to that part of the bone.

With the different types of approach, there are also different experiences post-surgery.

As a general rule, those who have a traditional shoulder replacement tend to get more range of motion back following rehabilitation.

Those with a reverse total shoulder tend to get less range of motion back, but typically have less pain during recovery.

Conservative Treatment Options

physical therapist assessing an older adult's shoulder

Before surgery, conservative treatments like medications, physical therapy, and injections are often tried.

These methods are typically effective for patients with less severe joint damage or those who can manage their symptoms without surgery (AAOS, n.d.).

As a physical therapist, I typically recommend starting with physical therapy. If physical therapy is all that’s needed and a surgery can be avoided (especially a joint replacement) then you saved yourself a lot of time, money, and pain.

If a surgery is required, that’s okay, but at least you know you exhausted your options before jumping right into surgery.

Recovery and Physical Therapy

person wearing shoulder sling

Post-Surgery Recovery

As with all procedures, your recovery journey will be specific to you, however, the following are some general ideas on how the recovery process may flow:

  • Hospital Stay: Many patients are discharged the same day as the surgery (Mayo Clinic, n.d.).
  • Physical Therapy: Begins the day after surgery with gentle movements, gradually increasing in intensity (Johns Hopkins Medicine, n.d.).
  • Full Recovery: The complete recovery process and return to normal activities can take several weeks to months, depending on the surgery type and patient adherence to rehabilitation (Johns Hopkins Medicine, n.d.).

Additionally, right after surgery, most surgeons will place the arm in an immobilizer (big sling) for 4-6 weeks.

Within the first couple weeks you’ll likely start physical therapy with passive range of motion exercises, light movements in the arm/shoulder.

From weeks 8-12 after surgery is where more functional exercises will occur (Indiana University, 2023).

Exercises Post-Shoulder Replacement

Once cleared by a surgeon, specific exercises can aid in recovery. The following are exercises you’ll likely receive from your PT once you’re cleared for movement.

  1. Pendulum Exercise:
    • Lean forward slightly, supporting yourself with your good arm
    • Let the affected arm hang down loosely
    • Gently sway from your legs, in small circles, allowing for the arm to move without actively moving the arm
    • Repeat 8-10 times
    • Take 1-3 minute rest
    • Complete 3 sets
  2. Active Assist Arm Raises:
    • Lie on your back with your arms at your sides
    • Hold the wrist of the affected arm with your non-affected arm and slowly move it overhead
    • Hold for five seconds at top of your range
    • Gently lower back to the starting position
    • Repeat 8-10 times
    • Take 1-3 minute rest
    • Complete 3 sets
  3. Towel Slides:
    • Stand facing a window or smooth wall
    • Place folded towel under your affected hand
    • Slide towel up, as high as you can
    • Hold for a five seconds, then slide towel back down, with control
    • Repeat 8-10 times
    • Take 1-3 minute rest
    • Complete 3 sets
  4. Sidelying Flexion with Ball:
    • Lay on your non-operated side, with a small physioball under affected hand
    • Roll ball towards head, as high as you’re able
    • Hold for 5 seconds
    • Return ball to starting position
    • Repeat 8-10 times
    • Take 1-3 minute rest
    • Complete 3 sets
  5. IR Isometrics:
    • Stand facing the corner of a wall, so that your arms could move on either side of the wall if you could lift your arms equally
    • Place towel against wall and place affected forearm on the towel with elbow bent
    • Press into the towel at the forearm
    • Hold for 30 seconds, breathing
    • Take 1-3 minute rest
    • Complete 3 sets

In Summary

Shoulder replacement surgery, whether traditional or reverse, can significantly improve life quality for older adults with severe shoulder issues.

However, it’s important to be informed, understand all of your options, and if possible, try conservative treatment (physical therapy) first.

Understanding the surgery types, recovery expectations, and the importance of rehabilitation exercises are crucial for successful outcomes.

References:

Note: The exercises listed should only be performed after clearance from a surgeon and under the guidance of a physical therapist.

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