Rehabilitation after shoulder arthroplasty

BACKGROUND: Reverse shoulder arthroplasty is an effective surgical treatment for severe degenerative and post-traumatic conditions of the shoulder joint. However, despite its proven clinical efficacy, the optimal scope of medical rehabilitation required to maximize functional outcomes and quality of life remains unclear.

AIM: This study aimed to assess the efficacy of a specialized medical rehabilitation program after reverse shoulder arthroplasty based on modern techniques, including isokinetic dynamometry and biofeedback training.

METHODS: A comparative cohort study was conducted in 33 patients with omarthrosis who underwent reverse shoulder arthroplasty. The patients were divided into two groups. The treatment group (n = 17) underwent a structured rehabilitation program developed by the authors, whereas the control group (n = 16) did not receive organized rehabilitation. The primary endpoint was recovery of shoulder joint function, including range of motion, muscle strength, coordination, and patient-reported quality of life. Assessment methods included goniometry, isokinetic dynamometry, evaluation of complex coordinated movement abilities, volumetric analysis of upper limb motion using a spherical motion sector, and patient questionnaires (DASH, PSS, SF-36).

RESULTS: Patients who underwent the medical rehabilitation program had significantly better functional outcomes than the control group. Abduction range was 150° [150°–160°] in the treatment group vs. 107.5° [93.75°–140°] in the control group (p < 0.001). Flexion range was 160° [150°–165°] in the treatment group vs. 120° [107.5°–133.8°] in the control group (p < 0.001). External rotation range was also greater in the treatment group: 45° [40°–55°] vs. 25° [20°–36.3°], p < 0.001. Abduction strength reached 23.6 Nm [19.3–32.4] in the treatment group vs. 16.7 Nm [9.93–20.6] in the control group (p = 0.005). The spherical motion sector volume in the treatment group was 230,778 cm³ [207,921–268,565], exceeding that of the control group: 126,952 cm³ [107,894.25–151,971.3], p = 0.001. Correlation analysis revealed a strong positive relationship between shoulder joint range of motion and coordination parameters (r = 0.78, p < 0.001), as well as muscle strength (r = 0.71, p < 0.001). Moreover, higher patient-reported satisfaction scores (SF-36) were associated with increased muscle strength and greater external rotation range (r = 0.63, p = 0.002).

CONCLUSION: Implementing a comprehensive, personalized rehabilitation program after shoulder arthroplasty significantly improves functional outcomes. Optimized medical rehabilitation programs will improve the quality of medical care and long-term clinical outcomes in patients following reverse shoulder arthroplasty.