Shoulder rehab advice for my 83 year old dad

Medical Q&A [Moderated]
1

Dear BBM crew,

My dad (83 yo) recently visited an orthopedic doctor who explained to him that he has severe OA in his right shoulder to the point he might need joint replacement surgery. I myself am a physical therapist and an avid consumer of BBM content, and I want to attempt to help my dad rehab his shoulder. He has never been an active person and doesn’t really like working out. All he really wants is for his shoulder to feel better. I know from your content that radiographic evidence of OA has little diagnostic utility when it comes to knee OA, and I was wondering if the same applies to shoulder OA? My initial instinct is to educate him on the biopsychosocial model of pain and to find his “entry point” into exercise to hopefully desensitize his shoulder and lower the threat level around movement/exercise. I think its going to be difficult for him to unlearn the biomechanical model of the body that has continually been reinforced to him by medical professionals throughout his life. I guess I am hoping for some advice on how to frame the discussion in a way that will promote buy-in, foster confidence and self-efficacy, and improve the chances of consistent adherence to a rehab program. Are there any specific motivational interviewing strategies or analogies that you guys have success with in similar situations? Also, his case is complicated by a hemorraghic stroke he suffered a few years back that left him with slight weakness, motor coordination and visual perception/processing deficits on the R side of his body (which is the painful shoulder side). Right now, he is physically unable to elevate his arm more than about 45 degrees. I just want to help him feel better and would really like to avoid him undergoing unnecessary surgery. Any and all advice is greatly appreciated!

2

Hi there,

While it is true that radiographic evidence has imperfect correlation with clinical OA severity at all joints, the question that first struck me here is, why did he go see the orthopedist? Presumably he is having symptoms in the area that are impairing his function and/or quality of life.

From there, we need to recognize that even if he were to undergo surgery, there would be a period of necessary post-operative rehab afterwards. Unless his current symptoms make such rehab completely intolerable right now, it is often worth trying a period of pre-operative rehab, as I’m sure you know.

Getting buy-in can be tricky, but I agree with your instinctual approach, after eliciting his current understanding, beliefs, and expectations. Depending on your relationship with him, you may or may not be able to address these as his son, versus getting an “outside professional” perspective whom he might trust.

Our strategies and recommendations have been discussed at some length in our existing content on this topic, most recently the “Osteoarthritis Teaching Rounds” podcast episode #323. Beyond that, we would be happy to consult for more individualized conversation and advice, if that would be helpful.