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TSA Case Study
TSA Case Study
DPT 751
July 12, 2010
-Hemiarthroplasty: for
patients with either
severe cuff pathology or
irreparable cuff1
-replacement of humeral
head
Drake GN, OConnor DP, Edwards TB. Indications for reverse total shoulder arthroplasty in rotator cuff disease.
Clin Orthop Relat Res. 2010;468:1526-1533.
Indications1,3
Contraindications3
-Advanced glenoid
destruction
-Severe lesions of deltoid
-Axillary nerve palsy
-Patient with expectation
of high functional return
-Post-op complications3
-Hardware instability or dislocation (abd with ER)
-Nerve damage
-Infection
-Hematoma
-Intra-operative fracture
-76y/o female
-Referred to PT s/p right rTSA (05/14/10)
-Previous injury: fall 07/16/09
-Previous sx: RCR Sept 2009
-PMHx: Parkinsons Disease (1997), CVA (1996), PAD,
breast cancer (R mastectomy), memory loss
-Social hx: retired, does not drive
-Parkinsons
-Observation
-PROM
90 flex
-Rounded shoulders
60 abd
-FHP
11 ER
-Increased thoracic kyphosis
-5 elbow ext
-Reverse scapular rhythm
-Palpation
-Scar mildly adhered
-Tender over anterolateral
-Neuro Screen
incision & mid belly of biceps
-Quick DASH: 72%
-Intact to LT bilaterally
(0-100%, higher score
-Postural instability
indicates more disability)
-B UE pill rolling tremor
-Jaw tremor
-Decreased facial expressions
-Sling 4 weeks
-Potential for instability due to design
-No active IR or extension for 6 weeks1
-Pt must be able to visualize elbow while lying supine
(no hyperextension)
-No resisted IR or extension for 12 weeks
-No IR, adduction, extension (tucking in shirt) for 12 weeks
-STG: 5 weeks
1-MinA with
established HEP
2- Decrease in pain
by 50%
-LTG: 10 weeks
1- Able to wash &
comb hair with R UE
independently
2- R UE AROM within
75% of L UE AROM
3- Decreased QuickDASH by 50%
(day 1 to week 6)
(weeks 6-12)
(weeks 12-16)
(months 4+)
-3-4x/wk
-strength gains, return to functional/recreational activities
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
Initial
4 weeks
6 weeks
Flex
Abd
ER
Pain (x/10)
-PIPs
1- Difficulty washing & combing hair
2- Difficulty with household chores
3- Shoulder pain
-Non- PIPs
1- Swinging arms during gait
2- Right arm strength
MET
-STG: 5 weeks
1-MinA with established HEP
MET
2- Decrease in pain by 50%
MET
-LTG: 10 weeks
1- Able to wash & comb hair with R UE independently ?
2- R UE AROM within 75% of L UE AROM
?
3- Decreased Quick-DASH by 50%
72% > 52%
(MCID=15pts)5
-60 pts (mean age 70yrs) with glenohumeral arthritis associated with severe RC
deficiency treated with rTSA, followed for minimum of 2 yrs
-2 groups: previous RC repair, no previous surgery
-Intervention: PROM started day 2, sling worn for 4 weeks, AAROM began @
4wks, AROM started @ 8wks, resisted exercises @ 12wks
-All measures improved significantly (p<0.001)
-ASES increased 33.9pts
-VAS decreased 4.1pts
-ROM: flexion increased 50, abduction 60, ER 29
-No significant difference between 2 groups in terms of demographic data,
preoperative scores, post-op VAS scores, ROM
-Device failed in 7 pts, requiring revision @ average of 21.4 months (insuffient
bone density, glenoid loosening)
-Results suggest that arthroplasty with rTSA may be a viable treatment for pts w/
GH arthritis & a massive RC tear, future studies need to determine the
longevity of the implant
THANK YOU!
1. Boudreau S, Boudreau E, Higgins LD, Wilcox RG. Rehabilitation following reverse total shoulder
arthroplasty. JOSPT 2007;37:734-743.
2. Drake GN, OConnor DP, Edwards TB. Indications for reverse total shoulder arthroplasty in rotator
cuff disease. Clin Orthop Relat Res. 2010;468:1526-1533.
3. Volpe S, Craig JA. Postoperative physical therapy management of a reverse total shoulder
arthroplasty (rTSA). Ortho Practice. 2007;21:11-17.
4. Boileau P, Watkinson D, Hatz AM, Hovorka I. Neer Award 2005: The Grammont reverse shoulder
prosthesis: Results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder
Elbow Surg. 2006;15:527-540.
5. Beaton DE, Katz JN, Fossell AH, et al. Measuring the whole or the parts? Validity, reliability and
responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in
difference regions of the upper extremity. J Hand Ther. 2001;14:128-146.
6. Frankle M, Siegal S, Pupello D, et al. The reverse shoulder prosthesis for glenohumeral arthritis
associated with severe rotator cuff deficiency. J Bone Joint Surg. 2005;87:1697-1704.
7. Koch LD, Cofield RH, Ahlskog JE. Total shoulder arthroplasty in patients with Parkinsons
Disease. J Shoulder Elbow Surg. 1997;6:24-28.
8. Kryzak TJ, Sperling JW, Schleck CD, Cofield RH. Total shoulder arthroplasty in patients with
Parkinsons Disease. J Shoulder Elbow Surg. 2009;18:96-99.
9. Farley BG, Koshland GF. Training BIG to move faster: the application of the speed- amplitude
relation as a rehabilitation strategy for people with Parkinsons Disease. Exp Br Res
2005;167:462-467.