Abstract
Introduction
Schoulder function in the rheumatoid patient is often restricted by pain and the decrease of range of motion, muscle strength and coordination. The aim of treatment in particular joint replacement is to improve one or more of these factors to enhance shoulder function. It is unknown how much range of motion of the shoulder and the glenohumeral joint is actually needed after shoulder replacement for a reasonable function.
Methods
The shoulder function of 114 rheumatoid patients (28 male and 86 female) with a shoulder replacement was pre- and post-operatively scored at regular intervals with the Constant scale and the HSS scoring system. These scoring systems measure the ROM and daily functioning. Activities of daily living used were: dress, comb hair, wash opposite axilla and use toilet and these items were scored numerically (5=normal, 0=impossible). These items were correlated with the active ROM of the shoulder and the passive ROM of the glenohumeral joint. The passive ROM of the glenohumeral joint included the ab/adduction movement in the frontal plane, the rotation in resting position and the exorotation in 90° anteflexion. 54 Patients had a hemi-arthroplasty and 60 patients had a total shoulder prosthesis. The average follow-up was 5 years.
Results
The average active ROM measured at follow-up was: flexion 81°±36; abduction 70°±27; exorotation 21°±23. The average passive glenohumeral motion was: exorotation in 90° flexion 42°±33; ab/adduction 51°±21; rotation 61°±30. The average functional score of the activities of daily living measured were: comb hair 2. 8±1. 9; toilet use 3. 9±1. 6 and wash opposite axilla 4±1. 5. There was a significant relationship between flexion/rotation and the functional task comb hair. The other activities of daily living were not significantly related with ROM of the shoulder. The minimal range of motion for optimal functioning of the shoulder was calculated.
Discussion
Exorotation of the 90° flexed shoulder appears to be the most important parameter for an optimal functioning after shoulder prosthesis.
