Problems in the rehabilitation of patients following total shoulder replacement surgery - case study

There are a number of indications for total joint replacement surgery, mainly degenerative changes with limited function, rheumatoid arthritis, post-traumatic changes, arthropathy accompanying rotator cuff injuries. Problems in the rehabilitation of patients following partial or total shoulder joint replacement surgery result from the anatomy and biomechanics of the shoulder, including extensive joint mobility range, relatively weak muscle stabilization and a frequent need to reconstruct the rotator muscles and joint capsule. The aim of this paper is to present problems in the rehabilitation of a patient following total shoulder replacement surgery. A female patient (St. G., 69) was involved in a traffic accident and, immediately after the accident, underwent surgery with stabilisation of the bone fragments with Kirschner wires. Five years following the operation, the patient was qualified for total shoulder replacement surgery on account of pain, limited mobility and muscle weakness. One year later, the patient was admitted to the Rehabilitation Department at the Regional Hospital No. 2 in Rzeszów for rehabilitation. The main goals of the rehabilitation were improvement of neuromuscular control of the scapula, reduction of pain, restoration of the function of muscles supplying the glenohumeral joint, and improvement of the range of joint mobility. Total shoulder replacement is a difficult operative procedure and its outcomes are often unsatisfactory to the patient. Pain reduction and improvement of limb function are good postoperative outcomes. A satisfactory result of total shoulder replacement depends on the experience of the operator, physiotherapist and an appropriate rehabilitation programme. Rehabilitation following partial shoulder replacement should be designed not only to increase shoulder joint mobility, but also to restore the entire stabilization mechanism, and improve upper limb function.