title: Immediate versus delayed passive range of motion following total shoulder arthroplasty.
abstract: BACKGROUND
  The goal of this study was to compare immediate with delayed range of motion (ROM) following total shoulder arthroplasty (TSA). The hypothesis was that ROM gains would occur earlier with immediate motion but that there would be no difference in ultimate ROM or functional outcome.
  
  
  METHODS
  Sixty patients were randomized to immediate motion (IM) or delayed motion (DM) following TSA. A lesser tuberosity osteotomy was performed in all cases. ROM and functional outcome were compared at 4 weeks, 8 weeks, 3 months, 6 months, and 1 year postoperatively.
  
  
  RESULTS
  Compared with preoperative values, in the IM group, forward flexion improved from 106° to 141° at 1 year postoperatively, external rotation improved from 21° to 65°, and internal rotation improved by 2 spinal levels (P < .05). In the DM group, forward flexion improved from 104° to 144°, external rotation improved from 20° to 53°, and internal rotation improved by 4 spinal levels (P < .05). The 2 groups regained motion differently, but there were no significant differences in final ROM or functional outcome scores between the 2 groups. The IM group had higher functional outcome scores initially, but by 3 months postoperatively, there was no difference. The rate of osteotomy healing was 81% in the IM group compared with 96% in the DM group (P = .101).
  
  
  CONCLUSIONS
  Immediate ROM provides a more rapid return of function compared with a delayed ROM protocol following TSA. However, there are no differences in ultimate ROM or functional outcome between the 2 groups. Moreover, immediate ROM may lower the healing rate of a lesser tuberosity osteotomy.
authors.affiliation: Southern Oregon Orthopedics, Medford, OR, USA; Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA. Electronic address: pjdenard@gmail.com.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Denard
authors.affiliation: Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lädermann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012399:Rotation; D012785:Shoulder Joint / Q000601:surgery; D061665:Time-to-Treatment; D064232:Visual Analog Scale; D014945:Wound Healing
keywords: Shoulder arthroplasty; delayed motion; functional outcome; lesser tuberosity osteotomy; passive motion; rehabilitation