| Author |
Level of Evidence |
Number of patients |
Follow-up |
Rehabilitation protocol* |
Conclusion |
Babhulkar et al. [9]
(India) |
Case series – level III |
27 patients |
2 and 6 weeks & 3 and 6 month |
4 phases |
neither the injury-to-surgery interval, the age, the gender of the patients nor the fracture type had a significant impact on the outcome
therefore it is shown that a hemiarthroplasty is the best treatment for a proximal humeral fracture |
Mulieri et al. [10]
(USA) |
Case-Controls-Study – level III |
81 patients – 2 groups (A: 43 pat., B: 38 pat.) |
3,6 & 12 month |
4 phases |
2 groups: A: formal physical therapy, B: home-based program
There are no significant differences between the two groups in the ASES and simple shoulder test in the final follow up. But Mulieri et al. mention in functional approach after 4 weeks – they train active-assisted in diagonal patters. |
Bourdreau et al. [3]
(USA) |
Narrative review – level IV |
n/s |
n/s |
4 phases |
Rehabilitation of rTSA is different to a non-reversed TSA.
3 major aims: a) joint protection, b) deltoid function and c) ROM |
Agorastides et al. [6]
(England) |
RCT – level I b |
59 patients – 2 groups (early: 31 pat., late: 28 pat.) |
12 month |
Early: 3 phases
Late: 2 phases (or 3 phases, if phase 1 is the immobilization) |
No significant difference in the constant Shoulder Assessment & Oxford score between the 2 groups. The late group had less pain and was better in ADLs. They also show a trend to less tuberosity migration. |
Amirfeyz, Sarangi [7]
(England) |
Case series – level III |
40 patients |
3,6 and 12 month |
2 phases |
Postoperative immobilization (4 weeks sling) does not lead to shoulder stiffness. |
Boardman et al. [4]
(USA) |
Case series – level III
|
80 patients |
2 years |
Home based program – 3 phases |
Reasonably safe, effective and user-friendly program |
Brown, Friedman [11]
(USA) |
Survey article/ narrative review – level IV |
n/s |
n/s |
4 phases |
The rehabilitation program should include a preoperative visit and must be individual. The time the different phases start is not that important than the order of the exercises – maximizing motion to aggressive strengthening. |
Brems [5]
(USA) |
Survey article/ narrative review – level IV |
n/s |
n/s |
3 phases |
Main aims: maximum ROM and high strength level.
4 key-points: 1. early therapy beginning, 2. allow active movement as soon as possible, 3. any aids should be reduced, also the sling and 4. maximum passive ROM in the first phase before starting with the strengthening |
Wilcox et al. [8]
(USA) |
Narrative Review/
clinical commentary – level IV |
n/s |
n/s |
4 phases |
Achieving the next step does not follow a time-line, as in most other reports in the literature, but considers the healing progress, measured as ROM and strength, as significant parameters to continue in a personalized training program |
Wicker et al. [13]
(Austria) |
Survey article/
narrative review – level IV |
n/s |
n/s |
3 phases |
sensomotoric function of the shoulder has to be focused on and the program has to be individual and early functional |
| |
|
|
|
*: see Table 4 for further details
rTSA: reversed total shoulder arthroplasty
ASES: American shoulder and elbow surgeons score for pain
ROM: range of motion
ADL: activity of daily living |
