Tuesday, November 26, 2013

Shoulder replacement, is it right for me?

Shoulder pain can be a debilitating condition. A range of issues can be the cause of this pain, from tendon and ligament tears that are more common in younger patients, to arthritis which more commonly affects middle-aged and older patients. Options for treating shoulder arthritis have increased dramatically in the last decade due to new technologies and research that has helped surgeons better understand the best approach to treating the various causes of shoulder pain in the older patient. Today I’d like to focus on that research, which predominantly involves shoulder arthroplasty, or replacement.



As in other joints in the body, the shoulder joint relies on smooth articular cartilage that lines the bones which form the joint. This smooth surface allows the shoulder to glide through a remarkable range of motion. If however the cartilage starts to thin out, those surfaces are no longer smooth. The human body will often react by forming bone spurs, or osteophytes, in an attempt to limit motion at this no longer smooth surface. This can result in further pain and loss of motion in the shoulder. At the same time, the muscles that stabilize the shoulder, the rotator cuff, can also be tearing. This can lead to further problems such as weakness in the shoulder, damage to the biceps tendon, and a special type of arthritis called rotator cuff arthropathy.




When this occurs, you will often notice pain, especially at night, in the shoulder. Motion will be lost, especially in attempting to reach overhead or behind your back. The shoulder may like it is grinding as well. If these symptoms are occurring the next step is to be seen in the office and evaluated by your surgeon. This will involve a physical exam and likely x-rays of the shoulder. In most cases of shoulder arthritis this is often enough testing to provide an accurate diagnosis and treatment plan. Sometimes an MRI or CT scan can be helpful for a more detailed assessment of the soft tissue and bony structure of the shoulder. Depending on the amount of cartilage loss and other damage to the shoulder, multiple treatment options exist. This can range from oral medications, ice, and physical therapy, to cortisone injections, to surgery.



The most predictable option to relieve arthritis of the shoulder joint is total joint replacement, or arthroplasty. This involves surgery to implant a combination and metal and plastic components that restore a smooth surface to the joint, improving motion and relieving pain. Standard arthroplasty is the most common option, with the newer reverse arthroplasty that I have displayed below an option for situations where there is a deficient rotator cuff. The surgery involves being placed under general anesthesia and several days stay in the hospital. After the replacement you can expect to wear a sling for 4-6 weeks and participate in physical therapy to focus on regaining motion and strength in the shoulder. Full recovery can take 3-4 months. Shoulder replacement surgery is highly successful. Risks of the surgery can involve infection, nerve injury, fracture, prosthesis related problems, and stiffness. Talk to your surgeon to discuss your specific condition and see if this surgery is an option for you.