ORIGINAL ARTICLE Anne Marit Mengshoel Æ Bente Slungaard Effects of shoulder arthroplasty and exercise in patients with rheumatoid arthritis Received: 6 May 2004 / Accepted: 1 September 2004 / Published online: 26 November 2004 Ó Clinical Rheumatology 2004 Abstract The aim of this study was to examine pain and shoulder function in patients with rheumatoid arthritis (RA) before and after shoulder arthroplasty and post- operative exercise. Twenty-four patients (26 shoulders) were consecutively included in a multicentre study. Be- fore surgery, at discharge from hospital and after 3 and 6 months, perceived shoulder function and shoulder pain were assessed by visual analogue scales, activities of daily living by the Modified Health Assessment Questionnaire (M-HAQ) and shoulder range of motion (ROM) by a goniometer. All patients showed considerable pain reduction at discharge from hospital (p<0.001). In those with intact rotator cuff and biceps tendon (n=13) improvements were found after 6 months in active and passive abduction and flexion ROMs (p<0.01) and in M-HAQ (p<0.001). Such improvements were not found in those with torn soft tissue (n=12). Preoperatively, abduction and flexion motor deficits (passive RO- M >active ROM) were found for the total group (p=0.001). Less flexion motor deficit was found in the intact soft tissue than in the torn soft tissue group after 3 (p=0.002) and 6 months (p<0.001). No group difference was found with respect to abduction motor deficit. In conclusion, pain relief was obtained by all patients. Im- provements in ROMs and activities of daily living were influenced by the state of the soft tissue. Keywords Exercise Æ Physiotherapy Æ Rheumatoid arthritis Æ Rotator cuff Æ Shoulder arthroplasty Introduction Rheumatoid arthritis (RA) is an autoimmune inflam- matory disease frequently starting with joint inflamma- tion in the small joints of the hands and feet. However, debut in the shoulder joint has been reported in about 20% of the patients [1]. Shoulders may also be affected later in the disease process, and in a hospitalised group of patients about 90% were found to have problems with their shoulders [2]. The main treatment goals in management of shoulder problems are to reduce pain and to improve shoulder function. When the shoulder joint has degenerated, shoulder arthroplasty and post- operative exercise are usually offered. Investigations of the long-time outcomes after 2–13 years show a major reduction in pain, but only minor improvements in ac- tive range of motion (ROM) and activities of daily living (ADL) after total arthroplasty [3–7] and hemiarthropl- asty [3, 8, 9]. The small improvements in shoulder function years afterwards might be explained by the progressive nature of RA, but it might also be that the exercise programmes should be better. As far as we know, the effects at an early postoperative stage related to postoperative exercise have not yet been reported. The ‘‘new’’ shoulder joint increases the motion within the joint. Probably, this increases the patient’s ability to perform passive ROM. Long-standing pain can inhibit the muscles. The pain relief seen after shoulder arthro- plasty [3–7] should reduce this inhibition. Hence, new premises are given for performing both passive and ac- tive shoulder function during postoperative exercise programmes. Our clinical experience was that the pa- tients with RA might have greater passive ROM than they can benefit from during active movements. There- fore, it was assumed that motor deficit was identified in cases where passive ROM was considerably greater than the corresponding active ROM. Consequently, the dif- ferences between active and passive ROM were calcu- lated and applied as a measure of motor deficit. The exercise programmes were aimed at improving these Sources of support: From EXTRA-funds from the Norwegian Foundation for Health and Rehabilitation A. M. Mengshoel (&) Institute of Nursing and Health Sciences, Medical Faculty, University of Oslo, Box 1153, Blindern, 0316 Oslo, Norway E-mail: a.m.mengshoel@medisin.uio.no Tel.: +47-22-858413 Fax: +47-22-858411 B. Slungaard Martina Hansen Hospital, County of Bærum, Norway Clin Rheumatol (2005) 24: 258–265 DOI 10.1007/s10067-004-1026-0