The patient was a 39-year-old woman with a 3-month history of worsening right distal humerus pain that was insidious in onset. At the time of the initial physical therapy visit, the patient complained of weakness and numbness throughout the entire right upper extremity, with an inability to perform daily activities. Magnetic resonance imaging revealed extensive bone marrow signal abnormalities extending from the proximal humeral epiphysis to the distal humeral diaphysis. Further evaluation with radiographs and computed tomography revealed multiple lytic lesions through the humerus. Tissue biopsy confirmed a diagnosis of cystic fibrous dysplasia.

J Orthop Sports Phys Ther 2011;41(6):459. doi:10.2519/jospt.2011.0413

KEY WORDS: arm, computed tomography, magnetic resonance imaging, radiography, upper extremity

SYNOPSIS: Reverse or inverse total shoulder arthroplasty (rTSA) is becoming a widely accepted surgical intervention. This procedure is specifically designed for the treatment of glenohumeral (GH) joint arthritis or complex fractures, when associated with irreparable rotator cuff (RC) damage or in the presence of RC arthropathy. Additionally, rTSA is an option for the revision of a previously failed conventional total shoulder arthroplasty (TSA) or hemiarthroplasty (HA) in the RC-deficient shoulder. The physical therapist, surgeon, and patient must take into consideration that the postoperative course for a patient following rTSA should be different than the rehabilitation following a traditional TSA. rTSA has only recently been approved by the Food and Drug Administration in the United States; however, nearly a 20-year history of its use exists in Europe. To date, we are aware of no peer-reviewed published descriptions of the postoperative rehabilitation for patients having undergone this procedure. The purpose of this paper is to review the indications for rTSA, focusing on underlying pathology, and to outline a rehabilitation protocol founded on basic science principles and our experience working with patients following rTSA.

J Orthop Sports Phys Ther 2007;37(12):734-743, published online 28 August 2007. doi:10.2519/jospt.2007.2562

Study Design: Case report. Background: Patients with hyperflexion/hyperabduction injury to the glenohumeral joint are at risk for isolated greater tuberosity fractures, which are often undiagnosed or misdiagnosed. In this case report, we describe the clinical decision-making process that led to the diagnosis of an isolated greater tuberosity fracture and subsequent rotator cuff tear. Case Description: The patient was a 45-year-old male who sustained a shoulder injury as the result of a fall while skiing. After the initiation of physical therapy, he was diagnosed with an isolated greater tuberosity fracture. Little is known regarding the optimal management and overall prognosis of this type of fracture. Conservative nonoperative management and postoperative physical therapy management are discussed. Outcomes: With conservative nonoperative management, the patient was unable to regain high-level functional shoulder use. Suspicion of continued pathology of the greater tuberosity dictated further diagnostic imaging, which led to surgical intervention. Upon completion of postoperative rehabilitation, he was able to resume full recreational activities. Discussion: It is recommended that sound clinical decision-making dictate the management and ongoing evaluation of traumatic shoulder injuries, especially when managing a patient with an injury for which optimal treatment and prognosis is not well established.

J Orthop Sports Phys Ther. 2005;35(8):521-530. doi:10.2519/jospt.2005.1723

Key Words: diagnostic imaging, physical therapy, shoulder rehabilitation

The purpose of this paper is to review the indications for TSA, focusing on the underlying pathologies, and to describe the variables that impact the rehabilitation program of individuals who have had a TSA. A postoperative TSA rehabilitation protocol and algorithm, founded on basic science principles and tailored toward the specific clinical condition, are presented.

J Orthop Sports Phys Ther. 2005;35(12):821-836. doi:10.2519/jospt.2005.2000

Key Words: physical therapy, protocols, shoulder rehabilitation