The Ream and Run is a type of shoulder replacement suited to either young or highly active patients who wish to avoid the risks associated with potential failure of the polyethylene glenoid component. In this procedure, the glenoid is reamed and reshaped into a single, smooth concavity to provide a congruent and durable surface for articulation of the replaced humeral head.
By analyzing the outcomes over time of a large database of patients in a clinical registry of reverse shoulder replacement, Parsons and colleagues determined that while there is a small decline in overhead function of the arm, this decline is only marginally more than would be expected due to the normal aging process. The findings therefore challenge is this long accepted notion and suggest that the functional outcomes of reverse shoulder replacement are well sustained.
While this operation can lead to unrestricted activities after shoulder replacement, commitment on the patient’s part to achieve the desired level of function is critical. The collective experience of both patients and surgeons is that the rehabilitation after a Ream and Run is longer and more arduous but that great results can be achieved with patience, persistence and grit. Here are some of essential tips to succeed.
- Be determined and focus on the end goal, not the day to day. Fluctuations in pain are normal and the end result takes time and effort. Do the work.
- Don’t let pain during exercises stop you from achieving your goals. Realize that this is normal and accept it as part of the reality of recovery.
- Create a rehabilitation schedule and stick to it like glue. This should include some core strengthening and cardio as well.
- Early on, flexibility is more important than strengthening. A stiff Ream and Run will remain sore and stretching to the limits to achieve maximal range of motion needs to be the focus for the first several months.
- Use the rule of 25s. Do no progress with strengthening resistance until you can do 2 sets of 25 reps comfortably.
- Manage the pain effectively but without narcotics. Positive attitude and acceptance that pain is a normal part of the recovery are helpful. Routine use of Tylenol and anti-inflammatory medications can be helpful. Adequate rest and nutrition for healing are also key.
- Own your outcome. A good surgery is only half of the equation. Rehabilitation is essential to the recovery of a Ream and Run. This cannot be emphasized enough. Set goals and set high demands for yourself to achieve them.
- Realize that your shoulder has been weak often times for years and that recovery or strength can take up to 2 years after surgery. This is where persistence is important. There is never a time to stop to the recovery process.
- If it seems like it will never get better – don’t give up. Many patients will report continued pain past 6 months. This is normal for the Ream and Run. Do not let the slow recovery convince you that surgery was not a success.
- Commit to lifelong fitness. Ream and Run shoulders need maintenance just like an engine. You have to keep them strong and flexible for continued high function.