Should I Get a Total Shoulder Replacement? Considerations and How Physical Therapy Can Help

If you are regularly in pain or beginning to lose function in your shoulder, you may be considering a shoulder replacement. Any major surgery is a big decision with many things to plan for, including the time you will be out of work, how long your recovery will take, and the best care team to perform the procedure. Shoulder surgeries, especially, can be complex and require longer recovery and more intensive therapy afterward. So should you get a total shoulder replacement? And how can you best alleviate stress before and after your surgery? 

With some surgeries, you may not have a choice in whether you have the procedure. Still, there can be some variability with shoulder replacements, so seeking professional advice is never a bad idea. We see many EW Motion Therapy clients who have difficulties with their shoulders and are considering surgery. We try our best to answer their questions and try a more conservative treatment approach before they schedule their surgery. Even if our services do not fit your needs, we still want to discuss various shoulder replacements and other treatment options. 

This article discusses the types of total shoulder replacements, when you should consider the procedure, some ways to avoid or postpone a total replacement, and how physical therapy can help. With this information, you can discuss your options with your doctor and make the most educated decision for your health and well-being.

What are the types of total shoulder replacements? 

While there are various surgeries you can have on your shoulder, there are only two primary types of total replacements. Let’s go over each and what makes them different.

Anatomical total 

If you get an anatomical total shoulder replacement, the surgeon repositions the ball and socket exactly as they were before. This surgery can preserve the function of the rotator cuff if that muscle is still viable, which is why it is often used on younger populations. 

Reverse total 

In a reverse total shoulder replacement, the position of the ball and socket are switched - the socket is now on the moving end of your shoulder with your humerus. In this procedure, the rotator cuff might no longer be fully functional, but the deltoid has to be intact. Rotator cuff function can deteriorate with age or in a trauma case, which is why the reverse can have better mechanical outcomes for older populations and trauma patients.

When should you consider a total shoulder replacement? 

Many people do a total replacement when their quality of life or muscle/joint tissue deterioration no longer allows for more conservative measures. The pain or weakness in the joint may become too much to tolerate or continue to pacify with pain medication, or you may lose mobility in the joint, and you can no longer do the activities you want/need to do. You may even have trouble sleeping. Whatever the case, there is no going back from a total shoulder replacement - the endgame procedure completely reworks the joint structure. It is a big decision and one you should discuss at length with your doctor and physical therapist.

When can you avoid a total replacement? 

A total replacement can feel drastic, but when you need it, it is entirely necessary. However, there are other options you should exhaust before deciding to do a total replacement in your shoulder. For example, if you have not tried more conservative treatment options, like physical therapy, try those first. You might be able to regain some mobility and strength in your joint before you resort to surgery. 

The shoulder is a complex joint with many ligaments and muscles that control its mechanics and movement. The ultimate problem may lie with one of those ligaments and not the internal structure of the joint itself. For example, if you begin to experience mild arthritic symptoms and the mechanics of your joint are imbalanced, physical therapy could be a great option to decrease pain and improve your joint function. 

How can physical therapy help you avoid or postpone surgery? 

Depending on your specific injury and the function of your shoulder, physical therapy can help you either prevent a total shoulder replacement altogether or delay the procedure as long as possible. We’ll discuss each scenario and some treatment progressions you might see. In either case, your therapist will do a full-body assessment to see how decreased shoulder function might affect the rest of your body, and whether your joint has the proper mechanics to be successful. Additionally, the best physical therapists will discuss risk factors with you and help you make an educated decision. 

Postpone surgery

Sometimes, your joint function might be too far gone to avoid a total replacement altogether, but you and your physical therapist can implement some strategies to at least push back the date of your surgery. It is important to strengthen and ensure the function of the structures surrounding the shoulder so you can recover quickly after surgery. This includes your shoulder blade and your thoracic spine, as well as anything else putting stress on the joint. Your therapist can also help you modify daily activities to reduce stress on the joint.

Avoid surgery

If you have some shoulder function and moderate pain, and you have mostly intact structures surrounding your joint (rotator cuff, ligaments, etc.), then physical therapy could help you avoid surgery altogether. The best things your therapist can do preventatively are manual joint mobilization, strengthening, and increasing stability. Additionally, your core is the primary force behind all pushing, pulling, and lifting, so ensuring your core stabilizes your movements and not your shoulder joint can improve joint mechanics. Your therapist will also talk with you about repetitive activities you do during the day and modify any that are stressing the joint, including any lifting or reaching movements.  

How can physical therapy help you prepare for an upcoming surgery? 

Now you know more about total shoulder replacements and how physical therapy can be part of your care plan. If you have a total replacement on the calendar, physical therapy can begin to help you prepare months in advance. You can work to increase pain-free motion and joint stability, but not so much that you inflame the joint. You can talk with your therapist about posture or any other concerns. They can go over expectations after your surgery, such as dressing modifications and how to adapt daily activities as you heal. Surgery protocols vary, but you can often begin physical therapy the day of or the day after your surgery, so discuss those expectations with your surgeon to prevent scarring. 

No matter how prepared you may feel, a major surgery always comes with anxiety. Understanding all your treatment options is vital before you commit to a procedure, especially one as complicated as a total shoulder replacement. Whether you are considering an anatomical or reverse total replacement, a physical therapist can be a great member of your care team pre- and post-op. We love helping our clients at EW Motion Therapy feel confident and prepared to go into any procedure - our ultimate goal is to help them prepare, recover, and restore functional movement as soon as possible. If you are still curious about how physical therapy can help you prepare for surgery, click the button below to download our answers to 20 frequently-asked physical therapy questions.