Total Shoulder Replacement and shockwave therapy

[raafox]

Hi all,

we have a patient in our clinic who underwent a total shoulder replacement 8 months ago, initial response to the operation was very good, the patient regained 95% of his normal movement (better than any previous total shoulder I have ever seen!). He returned to full activity and at 6 months post-op he went walking in the mountains using Nordic walking poles (a larger version of a ski pole) since then his ROM is severely limited to 80 degrees abduction and 90 degrees flexion. He has returned to the surgeon and had several investigations into the prosthesis but they have failed to find anything significant to explain this sudden loss of range. They have referred back to physio with a request from the surgeon to use shockwave therapy (Extracorporeal shockwave therapy - Wikipedia, the free encyclopedia) on this patient's shoulder. In our clinic our initial response is not to use shockwave treatment due to the aggressive nature of the treatment and the possible loosening of the prosthesis. However from searching online literature is very limited on shockwave and its contraindications.

My question is first and foremost does anyone have any information on whether there any contraindications when treating joint replacements with shockwave therapy?

Secondly but less importantly, has anyone else experienced such a sudden loss in ROM in total shoulders with no clinical signs of loosening from a surgical point of view?

Thanks for your help


p.s. patient details are 70 year old man 9 months post-op, R shoulder, good health, nil of note medically, problem began 3 months ago, slow improvement now.

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[kennethckyuen]

Hi Raafox,

I used shockwave for my patients who had total knee replacement, aiming to break the scar tissue around the wound. I used 5mm depth only in order to avoid the wave going too deep to the prothesis. For the sudden lost of shoulder range, I suspect there would be a chance of muscle spasm or trigger points around the rotator cuff since the prothesis is in place confirmed by the doctor.

What do you think?

[nmarman]

We always do this cases by case there it not one rule. However, the sound wave will impede into different materials/ tissues at different rates.

Will scar tissue absorb enough of the energy before it hits the area of joint? To be frank I would be more inclined to uses non-ablative yag laser to help with scar tissue. Especially if the joint is ceramic.

[neurospast]

If I understand you right he went into the mountains walking with Nordic walking poles. Did he also wore a heavy back pack?
Has the focus been on the prothesis only? The reason I ask because over use of the Lattisimus Dorsi (potential shortening) could reduce the ROM in abduction and flexion of the shoulder. Have you looked at the performance of the whole shoulder girdle? I assume some form of imaging has been done f the Gleno-Humeral joint and no specific faults were found.
Just curious...