Reverse Shoulder Arthroplasty: A case report

Renuka Devi1, Mercy Ezhil Rani2

1Nursing Incharge, Kauvery Hospital, Hosur

2Clinical Educator, Kauvery Hospital, Hosur

Abstract

The reverse shoulder Arthroplasty conceived by Paul Grammont in 1985 has gradually gained popularity as a treatment for multiple shoulder diseases. Reverse total shoulder arthroplasty (RTSA) is increasingly gaining popularity worldwide in treating various traumatic and degenerative glenohumeral diseases and irreparable rotator cuff arthropathies.

A reverse shoulder Arthroplasty is a special type of shoulder surgery. During the surgery, a surgeon removes the damaged part of the shoulder and replaces it with an artificial part.

The shoulder joint comprises the upper arm bone (Humerus) and the shoulder blade (Scapula). The rounded end of the upper arm bone moves inside a shallow socket in the shoulder blade. Because of this, your shoulder normally has a very wide range of motion. Cartilage, tendons, and ligaments around the joints also support and help joints move smoothly.

Examination

Patient is conscious, oriented, a febrile

VitalsResults
BP130/80 mm Hg
Pulse78/min
Respiration22/min
CVSS1 S2 (+)
RSBilateral air entry
CNSNFND
P/ASoft

Final Diagnosis

Secondary Glen Humeral Arthritis with Glenoid Bone Loss in Right Shoulder.

Procedure

Right Reverse Shoulder Arthroplasty

Past History

The patient was evaluated for the case of glenohumeral arthritis in the right shoulder. Previously admitted for procedure RSA.

H/O Right shoulder pain on and off for 2 years.

H/O Restricted movement (+)

No H/O fever/Trauma

She was evaluated on an OPD basic – MRI right shoulder, which showed AVN of humeral head with joint incongruity with arthritis changes.

Case Presentation

A 35-year-old female patient evaluated the case of glenohumeral arthritis right shoulder. Patient Hemodynamically stable

BP – 120/80mmHg, PR – 90beats/min, RR – 16breaths/min, Spo2 – 99%. Temp – 98.6°F

Right shoulder contour – Altered

ROM severely restricted and painful.

 Investigations

InvestigationsResults
Hb10.4
TLC6500
Platelets2,84,000
INR1.11
PTT12.3
Potassium4.35
Sodium137.2
Blood groupO Positive
SerologyNegative

The Patient under general Anaesthesia, patient was in the position of a beach chair. We have painted and draped. Incision made through Delto-Pectoral approach about (12cm). The cephalic vein was isolated, and the pectoral major soft tissue tenodesis of Long head of the biceps tendon (LHBT) was performed. The clavipectoral fascia has been incised and the subscapularis has been peeled. An extensive osteoplasty was performed on the right humerus head with a total loss of contour. The proximal humerus has been prepared. Glenoid exposed and formed to be deformed. A central pin is inserted and glenoid preparation is performed. The Glenoid base plate of 28 mm rise has been inserted and fixed with three screws of 25mm, 30mm, and 35mm diameters. A Glenosphere of size 36 mm was inserted and a safety screw was inserted. A humerus stem size 2 was kept in 37 mm cups and inserted a size 0 in the stem. The wound closed in layers after being washed over the drain. Dressing was done. Extubation was done in recovery room. Procedure was uneventful.

Intensive Care Unit

  • Vitals monitoring and observation.
  • No oozing on the surgical site.
  • Patient was arousable and obeying commends.
  • Pain management done with IV antibiotics, antiemetics, analgesics.
  • Dressing done no oozing noted.
  • Drain was removed.
  • Discharged in stable condition.

Nursing Management Goals

  • Maintaining alignment of the affected joint and Managing pain and discomfort
  • Assisting with exercises
  • Providing routine postoperative care and preventing infection risk
  • Improve physical mobility and exercises
  • Administering medications
  • Initiating health education related to home care.

Nursing Interventions

  • Pain management: Administer pain medications as ordered. Analgesics
  • Vital signs: Monitor temperature, blood pressure, pulse, oxygen saturation.
  • Neurovascular assessment: Evaluate hand and arm function.
  • Wound care: Monitor dressing, drainage, and signs of infection. No Oozing. Patient is on arm pouch.
  • Mobility: Encourage shoulder mobility exercises.

Physical Therapy Protocol after Reverse Total Shoulder Arthroplasty

Phase I: Protection of Repair Immediate Post-Surgical Phase (Week 1-4)

In general, you will be in a sling with a strap around your waste and a pillow along your side. This will protect the part of the rotator cuff tendon, the subscapularis, which is in the front of your shoulder

Phase II: Active Range of Motion and Protection Phase (Week 5-8)

Gradually start to use your involved arm for daily activities including washing, dressing and feeding yourself. This will help you improve your active range of motion. Start driving when you feel confident in the use of your arm.

Phase III: Early strengthening phase (week 9-16)

Continue to improve motion by stretching the program. Start strengthening first with elastic bands and then light weights. Improved return to many activities but not yet sports.

Phase IV: Advanced strengthening phase and return to sports participation (week 13-22)

Continue to work on recovering pain free active motion doing the exercises outlined above. Advance conditioning exercises will be added to increase endurance and strength. Gradual return to skill sports such as tennis, golf, swimming can begin now.

Phase V: Return to full activity (week 23)

Gradual return to strenuous work activities. Gradual return to recreational activities, including sports. Continue strengthening. Continue stretching, if you continue to be tight.

Ms. Renuka Devi
Nursing Incharge

Ms. Mercy Ezhil Rani
Clinical Educator

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