Shoulder Arthritis and Replacements
Overview
The shoulder is a ball-and-socket joint made up of the humeral head (ball) and glenoid (socket). Since the glenoid is very shallow, the stability of the shoulder relies on various soft tissue restraints. The glenohumeral ligaments, which are thickenings of the shoulder capsule along with the labrum, which is a soft bumper that extends from the bony socket, give the shoulder stability. There is also dynamic stability imparted by the many muscles that cross the shoulder joint (including the rotator cuff), and when activated compress the humeral head into the glenoid. Cartilage provides the friction free gliding surface between the bones. When the cartilage inside the joint wears out, the underlying bone becomes exposed and osteoarthritis develops. Other patterns of damage may contribute to the development of arthritis within the shoulder.
Causes
Traumatic events, overuse, and genetics all play a role in the development of shoulder arthritis. Those who have had previous dislocations, surgery, and/or tears are more likely to develop arthritis. Primary glenohumeral osteoarthritis is most commonly a result of overuse and trauma. Rotator Cuff Arthropathy occurs because of long-standing rotator cuff tears.
Symptoms
Individuals with shoulder arthritis usually experience pain within the affected shoulder. Loss of motion, mechanical symptoms (such as popping, grinding, and catching), decreased strength, inability to perform daily activities, and difficulty sleeping are also common.
Diagnosis
A thorough physical examination will assess your strength, range of motion, and certain provocative tests can help narrow down the source of your symptoms. X-Rays will evaluate the extent of damage within the shoulder. Depending on if there are any major deformities, a CT scan helps with operative planning.
Treatment
Many patients with shoulder arthritis will have reasonable relief of their symptoms with simple non-operative measures. These will typically include activity modifications, or avoiding the maneuvers and activities that produce pain. Over the counter medications such as NSAIDs (Naproxen and Ibuprofen) and Tylenol are useful for mild to moderate arthritis discomfort.
Physical Therapy
Strengthening the dynamic stabilizers of the shoulder and improving the biomechanics of the shoulder girdle can be effective treatment for many types of shoulder arthritis. I generally advise against aggressive physical therapy, as this can exacerbate your symptoms.
Injections
The use of selective injections into the shoulder are effective temporary measures for the management of pain. Cortisone is the most common type of injectable and may provide relief for a number of months or longer. Platelet Rich Plasma (PRP) is another option. We advise against injections in close proximity to shoulder replacement surgery due to the increased risk of infection.
Surgery
All types of shoulder replacement surgery involves an open incision across the front of the shoulder. The damaged bone, bone spurs, and cartilage are removed and replaced with a smooth metal and plastic prosthesis. The surgery takes approximately 90 minutes and you are asleep under anesthesia. A special type of nerve block is also administered, which helps keep your shoulder and arm numb for the first day after surgery. Many patients can go home the same day as their replacement and do not require a stay in the hospital. A sling is utilized for the first 4 weeks after surgery, followed by a couple months of physical therapy to regain range of motion and strength. A full recovery can be expected by 6 months, with most people seeing dramatic improvements in their pain levels within the first month, followed by a return to basic every-day activities within the first 3 months after surgery.
Anatomic Total Shoulder Replacement. In a standard shoulder replacement, the joint is completely resurfaced and resembles the normal anatomy.
Reverse Total Shoulder Replacement. The joint is still completely resurfaced, but the ball and socket are reversed. The ball is attached to the scapula and the socket is implanted into the proximal humerus. This type of replacement can improve mechanics of the shoulder when the rotator cuff is severely damaged. A reverse prosthesis is used in other situations when there is extensive bone loss and for revision situations.
Partial Shoulder Replacement. In certain situations, just the ball is replaced (humeral head replacement). This can be in very young individuals and in those with avascular necrosis.
Shoulder Replacement Surgery in Oregon
Dr. Daniel Elkin is a leading Orthopedic Surgeon performing Shoulder Replacement Surgery in the Willamette Valley. He specializes in both anatomic and reverse shoulder replacements and is conveniently located in Salem, Oregon