Reverse Total Shoulder Replacement

You may be a candidate for reverse total shoulder replacement surgery if you suffer from large rotator cuff tears, shoulder arthritis, or arthropathy.

Reasons to consider a reverse shoulder replacement surgery.

Reverse or Inverse Total Shoulder Arthroplasty (rTSA) is designed specifically for the treatment of glenohumeral (GH) arthritis when it is associated with irreparable rotator cuff damage, complex fractures as well as for a revision of a previously failed conventional Total Shoulder Arthroplasty (TSA) in which the rotator cuff tendons are deficient. It was initially designed and used in Europe in the late 1980s by Grammont; only received FDA approval for use in the United States in March of 2004.

The rotator cuff is either absent or minimally involved with the rTSA; therefore, the rehabilitation for a patient following the rTSA is different than the rehabilitation following a traditional TSA. The surgeon, physical therapist, and patient need to take this into consideration when establishing the postoperative treatment plan.

You may shower with your watertight bandage in two days. Pat the dressing dry after your shower and do not submerge your wound.

The dressing will be removed in clinic at 2-3 weeks. Allow the steri-strips to fall off on their own (this could take up to 3 weeks).

You will be instructed by your surgeon to wear your sling for 4 weeks and the sling should be worn at all times.

While in the sling, the elbow should be bent at a right angle, and the hand should be level with your elbow or slightly higher. The elbow should be resting slightly in front of your body.

You may remove the sling for exercises as prescribed by the surgeon/therapist, icing, dressing, and showering.

Do not actively move your arm away from your body for 6 weeks following surgery. In addition, do not lift any object even if you are just bending your elbow.

When lying on your back we recommend you put a towel roll under your elbow to support your arm.

Many patients find that lying on a 30-degree incline wedge in bed is more comfortable than lying flat. Some patients find sleeping in a recliner more comfortable during the first few weeks after surgery.

Initially, after surgery, you should not reach behind your back with your operated arm.

You may use your wrist, hand, and elbow for daily activities. This includes eating, shaving, dressing, as long as you do not move your operated arm away from your body and it does not increase your pain.

Do not use your arm to push up/off the bed or chair for six weeks after your surgery.

When using your keyboard and mouse, do not move your arm away from your body.

When showering, you may wash under the involved armpit by bending forward to let the involved arm hang freely and reaching under with the opposite arm.

Physical therapy should usually be initiated within the 10-14 days following surgery. This includes physical therapy sessions at the clinic, in addition to a home exercise program for a range of motion and postural exercises. You will eventually be prescribed strengthening exercises.

You will be given a script for PT at discharge so you can schedule your appointment ahead of time to begin 14 days after your surgery.

You can take over-the-counter anti-inflammatories as needed. You can take Tylenol or any of the pain medications your surgeon prescribes. In addition, the use of frequent (3-4 times per day) icing of your shoulder will assist in pain management.

You may begin LIGHT strengthening around weeks 8-9 after surgery. This may be adjusted by your physician.

Return to activities is specific to the particular activity, but generally no sooner than 4-6 months. Always seek permission from your surgeon and therapist prior to starting any sports-related activity.

Please turn this paperwork in as soon as possible. This will allow time for it to be filled out prior to your procedure.

Please make an effort to include as much information as possible. Fill out any personal information – name, DOB, address, date of injury, employer information… etc.

The turn-around time for this paperwork is 7-10 days. Please understand the high volume of paperwork our office receives. We are unable to fill out this type of paperwork immediately/short notice.

Typically we recommend taking 2-3 weeks off of work for recovery. At that time we expect you will be off of pain medications and have more of your energy back.

If you are able to return to work in a sling – you would be able to go to work at that time.

Keep in mind – you are not able to drive while in the sling.

If your job requires any lifting, pushing, or pulling > 1-2 lbs or does not allow you to work while in a sling you may need to take additional time off of work. If you need a work note please discuss this in advance with Dr. Hofmann’s office.

Nonsurgical Treatment Options

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Physical Therapy

Doing exercises to strengthen and stretch the muscles that move the knee joint is important.

Local Injectables

Local injectable anesthetics numb the surrounding area by blocking pain signals from being sent to the brain, and may be beneficial to your treatment.

Medication

Taking a pain-relieving medication such as ibuprofen is a great option to start at home.