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Rehabilitation Following Shoulder Arthroplasty for Fracture

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Shoulder Arthroplasty

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Summary

Forty-three patients (46 shoulders) who underwent shoulder arthroplasty after fracture of the proximal humerus underwent rehabilitation and follow-up at a special reeducation center for an average of 3 months (1–6). The rehabilitation followed the protocol recommended by Neer (recovery of passive joint movements, muscular strengthening and stretching) to which were added hydrotherapy, physiotherapy and occupational therapy. The functional results, assessed after an average follow-up of 19 months, were disappointing with a normalised Constant score of only 60.2%. There appeared to be two factors which explained these poor results. Firstly, the advanced age of the population (52 older than 70) who was often poorly or non-motivated (22%) and debilitated (21% chronic alcoholics) and who had significant medical and neuro-psychiatric histories. Secondly, incompletely resolved anatomical and surgical problems: damage to the circumflex nerve (6.5%), early migration of the greater tuberosity (6.5%), secondary migration with malunion (15%) and/or nonunion (11%) of the greater tuberosity. These anatomical and surgical problems should be suspected clinically in patients who have an abnormally painful shoulder in the immediate postoperative period (16 cases in our series) and later if there is a dissociation between active anterior elevation (deficient) and passive anterior elevation (preserved) or if the range of active movement plateaus or regresses with time (24% and 9% of the patients in this series). The discrepancy between active and passive motion elevation suggests that limited motion is not caused by gleno-humeral scaring but instead by weakness of the deltoid (because of axillary lesion) and/or of the external rotators (because of greater tuberosity migration).

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Authors
  1. B. Caligaris-Cordero
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  2. F. Payeur
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  3. R. Sinnerton
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  4. P. Boileau
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Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery Hôpital de L’Archet, University of Lyon, 116, Rue Antoine Charial, 69003, Lyon, France

    Gilles Walch M.D.

  2. Department of Orthopaedic Surgery Hôpital de L’Archet, University of Nice, 151, Route de Saint-Antoine de Ginestière, 06200, Nice, France

    Pascal Boileau M.D.

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© 1999 Springer-Verlag Berlin Heidelberg

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Caligaris-Cordero, B., Payeur, F., Sinnerton, R., Boileau, P. (1999). Rehabilitation Following Shoulder Arthroplasty for Fracture. In: Walch, G., Boileau, P. (eds) Shoulder Arthroplasty. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-58365-0_42

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  • DOI: https://doi.org/10.1007/978-3-642-58365-0_42

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-63554-0

  • Online ISBN: 978-3-642-58365-0

  • eBook Packages: Springer Book Archive

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