Reverse Shoulder Arthroplasty Versus Physiotherapy Programs

Treatment ranges from physiotherapy to reverse total shoulder arthroplasty, with options in between such as superior capsule reconstruction, tendon transfer, partial repair, subacromial balloons and corticosteroid injections. The reverse shoulder moves the center of rotation, gives good results and is now used in younger patients, but complication rates average 15 to 20 percent and reach 39 percent in some studies, revision is more common in the young, and the cost is high. Physiotherapy success ranges from 32 to 96 percent. The anterior deltoid program has been tested in single-arm cohorts reporting 82 and 40 percent success, and in one randomized trial by Ainsworth with gains at 3 and 6 months that were no longer significant at 12. The speaker questions the rationale, since no study shows that the program isolates or grows the anterior deltoid, and prefers to call it a flexion-based program. The approaches of Collin's group and Gutierrez-Espinoza are described as well. No trials compare programs, so the best program is still unknown.