REHAB FOR REVERSE TOTAL SHOULDER ARTHROPLASTY (RTSA)
What is Reverse Total Shoulder Arthroplasty (RTSA)
The Reverse, or inverse, Total Shoulder Arthroplasty (RTSA), first described by Grammont et al [1], has recently gained popularity as a treatment option for patients requiring a shoulder replacement for the treatment of Gleno-Humeral (GH) joint arthritis when it is associated with irreparable Rotator Cuff (RC) damage, complex fractures, or for the revision of a previously failed conventional Total Shoulder Arthroplasty (TSA) in which the RC tendons are deficient/absent.
Biomechanics and Treatment
The biomechanical principle of RTSA is a shift of the rotational center medially and the distalisation of the humerus leading to increased deltoid tension and lever arms.
Due to these changes, the deltoid muscle is partially able to provide functional replacement of the rotator cuff muscles due to an increase in the deltoid moment arm and the muscular pretension [2].
Despite promising results in the early- and mid-term, a loss of function has been described for the long-term follow-up [2,3]. The loss of shoulder function may be due to degenerative changes of the deltoid muscle, thus being irreversible.
However, another factor might be the lack of exercise in elderly patients.
RTSA Treatment with SPM:
A rehabilitation program associated to RTSA is essential [3], in fact many authors stated that a successful outcome of RTSA depends on a well-designed and a well-executed physical therapy program [4]
Preoperative and postoperative muscle strengthening has been shown to improve the clinical outcome [3], suggesting that the use of electrostimulation can be beneficial during the rehabilitation phase.
SPM allows the patients to improve muscle recruitment patterns and consequently it’s the perfect device to be used pre and post RTSA.
RTSA stimulation protocol
What is the RTSA stimulation Protocol
The RTSA Protocol is available on App and it consists in a sequence of 12 exercises of varying intensity and duration distributed on 3-levels of increasing difficulty.
The aim of the rehabilitation sessions is to stimulate hypoactive muscle group throughout the motion exercises established in the protocol and it is indicated for the preoperative and postoperative rehabilitation associated to the Reverse Total Shoulder Arthroplasty (RTSA).
Electrode positioning for RTSA Protocol
To make sure that the motion exercises will be effective, the electrodes must be positioned correctly in the area of the nerve supplying the hypoactive muscles:
- The first electrode should be placed on the posterior part of the deltoideus muscle.
- The second electrode should be placed medially to the margo medialis scapulae to stimulate the scapula retractors (lower trapezius and rhomboids).
Duration of treatment
A minimum 3 sessions of treatment per week over a period of 3 months is suggested.
Longer periods of treatment can be indicated.
How do the exercises in the protocol work?
The RTSA protocol includes 12 exercises of varying intensity and duration.
Each exercise is structured for increasing difficulty using the force of gravity as a variable to modify the workload on the stabilizing muscles of the shoulder.
In some exercises the use of dumbbells is required to increase the resistance work.
This protocol has been developed in collaboration with:
Prof. Dr. med Patric Raiss
OCM Klinik München · Shoulder and Elbow Service
Dr. Leopold Albrecht
Physiotherapist – Therapeutic Management
Physioline Ganzheitliche Therapie (Munich, Germany)
SUPPORTING LITERATURE
[1] Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993;16:65-68.
[2] Boileau P, Watkinson DJ, Hatzidakis AM, Balg F (2005) Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elb Surg 14:147S–161S.
[3] Uschok et al, Reverse shoulder arthroplasty: the role of physical therapy on the clinical outcome in the mid-term to long-term follow-up, Archives of Orthopaedic and Trauma Surgery (2018), 138(12): 1647-1652
[4] Brems JJ (1994) Rehabilitation following total shoulder arthroplasty. Clin Orthop Relat Res 307:70–85
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