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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