Document Detail

Management of shoulder hemiarthroplasty in a patient with rheumatoid arthritis.
MedLine Citation:
PMID:  16915981     Owner:  NLM     Status:  MEDLINE    
STUDY DESIGN: Case report. BACKGROUND: Rehabilitation after shoulder hemiarthroplasty for rotator cuff tear arthropathy (RCTA) represents a significant challenge to physical therapists. Limited goals have been defined for this patient population and include no pain or slight pain at rest, moderate pain with vigorous activity, shoulder external rotation active range of motion (AROM) greater than 20 degrees, and shoulder abduction AROM greater than 90 degrees. CASE DESCRIPTION: The patient was a 60-year-old female elementary school teacher with functional class III adult-onset rheumatoid arthritis, who came to physical therapy 2 weeks after undergoing a hemiarthroplasty for RCTA of the right shoulder. Physical therapy included 33 treatment sessions involving 4 to 11 exercises each session. All sessions were performed under the direct supervision of a physical therapist utilizing specially designed equipment. Physical therapy emphasized early active assisted elevation range of motion (ROM), graded progressive exercise, and functional training. All exercises were performed in a pain-free ROM or a ROM that did not increase shoulder pain. OUTCOMES: Following physical therapy, subjective pain scale at rest was 0/10 and during vigorous activity 1/10 to 2/10. Shoulder AROM was normal and shoulder rotation and elevation strength was good. There was a significant improvement in shoulder proprioception and the patient demonstrated a negative belly press test for subscapularis muscle integrity. Additionally, the patient's score on the self-report section of the American Shoulder and Elbow Surgeons Assessment Form increased from 0% at the initial examination to 70% at discharge. DISCUSSION: Despite limited expectations, this patient achieved normal shoulder ROM and near normal shoulder strength after 14 weeks of physical therapy. Overall, an early, aggressive, progressively graded exercise program appears to be a safe and effective form of treatment after shoulder hemiarthroplasty for RCTA.
Darrin W Marsh
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Journal of orthopaedic and sports physical therapy     Volume:  36     ISSN:  0190-6011     ISO Abbreviation:  J Orthop Sports Phys Ther     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-08-18     Completed Date:  2006-11-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7908150     Medline TA:  J Orthop Sports Phys Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  600-10     Citation Subset:  IM    
Saco Bay Orthopaedic and Sports Physical Therapy, Kennebunk, ME, USA.
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MeSH Terms
Arthritis, Rheumatoid / physiopathology,  surgery*
Arthroplasty / rehabilitation*
Exercise Therapy*
Middle Aged
Physical Examination
Postoperative Period
Range of Motion, Articular
Shoulder Joint / physiopathology,  surgery*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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