“Get moving or take it easy for awhile” is a recurring issue with regard to range of motion (ROM) following total shoulder arthroplasty (TSA). Researchers in Oregon decided to investigate their hypothesis that improvements in ROM would happen earlier for those who got moving at an earlier point postoperatively.
ROM After TSA…To Move Immediately or Take it Easy
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Patrick J. Denard, M.D. is with Southern Oregon Orthopedics in Medford, Oregon. He told OTW, “First, I had adopted a delayed ROM protocol for arthroscopic rotator cuff repair and became convinced that the delayed ROM encouraged healing, particularly for larger tears. Second, I became interested in a retrospective study by Mark Frankle, M.D., who reported that ultimate ROM was higher in a group of patients in which he stopped using PT [physical therapy] and simply had his patients use a sling for six weeks after a TSA. Third, several studies have shown that subscapularis healing is important to function after TSA. Based on these factors I decided to study if a delayed ROM protocol following TSA would improve subscapularis healing without limiting ROM.”
“Subscapularis healing is vital to function following a TSA and an immediate ROM protocol is not necessary after a TSA for primary glenohumeral arthritis. In fact, immediate ROM may decrease subscapularis healing.”
Dr. Denard is also with the Department of Orthopaedics and Rehabilitation at Oregon Health & Science University. He explained, “We randomized 60 patients to immediate motion (IM) or delayed motion (DM) following TSA. After a lesser tuberosity osteotomy was performed in all cases, we compared ROM and functional outcome at 4 weeks, 8 weeks, 3 months, 6 months, and 1 year.”
“I expected the delayed group to take longer to regain their ROM but I thought it would take perhaps six months for them to obtain the same ROM as the immediate ROM group. But the differences between the two groups early on were less than I expected. More importantly, the osteotomy healing rate was lower in the group that moved immediately. Additionally, the patients who did not heal their osteotomy had a lower functional outcome. We therefore believe that any benefits of early mobilization following TSA are very short term and negated by the risk of decreased subscapularis healing.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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