Physical Therapy After Reverse Total Shoulder Arthroplasty

A common operation for various shoulder conditions is a total shoulder arthroplasty (TSA). In
cases with severe rotator cuff tears or other conditions, a variant of the procedure called a
reverse total shoulder arthroplasty may be performed. It is unclear whether or not patients
require formal physical therapy (as opposed to no physical therapy with recommended avoided
movements) after reverse TSA. Orthopaedic surgeons have varying opinions on the postoperative
rehabilitation protocol for reverse TSA, with some surgeons not prescribing any physical
therapy. The purpose of this study is to randomize patients into two groups: one that sees a
physical therapist after their reverse TSA, and one that is provided with actions not to
perform and are allowed to self-rehabilitate.

There is very limited orthopaedic literature focusing on the postoperative rehabilitation
after reverse TSA. The majority of research is in the physical therapy literature focusing on
the actual rehabilitation protocol. However, there has never been a large, randomized
clinical trial that asks the question of whether or not physical therapy after reverse TSA is
even necessary, or if patients will have comparable outcomes if they perform their own at
home rehabilitation. There are surgeons nationwide that are on either end of the spectrum.
Some encourage patients to see a therapist for a prolonged period of time with a set regimen
of exercises, while others do not encourage any formal physical therapy and instead give
patients a list of movements not to perform and allow them to recover at their own pace. We
hypothesize that there will be comparable clinical outcomes between patients randomized to
receive physical therapy versus an at home, self-led rehabilitation protocol. There are no
deleterious effects of either treatment wing.

Patients who agree to undergo reverse TSA after a preoperative appointment with their
attending surgeon will be invited to participate in the study. They will complete the below
mentioned survey instruments. They will receive their procedure and appropriate postoperative
treatment. Patients will then be randomized to either the physical therapy or self-rehab
group. Both groups will receive the standard postoperative physical therapy protocol. The
only difference between the groups will be if a physical therapist sees the patients in their
clinic, or if the patients self-rehabilitate with a list of limitations throughout their
recovery course. The physical therapy protocol provided to the physical therapists and
patients is attached.

Clinical outcomes will be measured using the attached survey instruments: Simple Shoulder
Test (SST), American Shoulder and Elbow Surgeons Shoulder Score (ASES-SS), and the Single
Assessment Numeric Evaluation score (SANE). These are commonly used, validated survey
instruments in the setting of orthopaedic shoulder research.

The physical exam component of the study will include range of motion testing (measuring the
degrees of movement using a goniometer) and strength testing (measured using the dynamometer)
in both shoulders.

These survey instruments and measurements will be performed at 3, 6, and 12 month
postoperative follow up.

Inclusion Criteria:

- • Patients who agree to receive a reverse total shoulder arthroplasty by one of our
participating surgeons

Exclusion Criteria:

- • Revision shoulder replacement surgery

- Mentally incompetent to provide informed consent

- Non-english speaking

- Minors (<18)

- Pregnant women

- Prison population

- Acute Shoulder Fractures