SHOULDER
Introduction:
When most people hear of “joint replacement” they usually think about hip and knee replacements. However, injuries of the shoulder and progressive arthritis can also damage the shoulder requiring a “shoulder replacement.” If you’ve ever been recommended a shoulder replacement or have been told that you may need one in the future, you are in the right place to get more information!
Total Shoulder Replacement:
The traditional total shoulder replacement is for patients with glenohumeral arthritis, also known as arthritis of the “ball and socket” of the shoulder. See Figure 1 and 2 below for normal anatomy and diseased anatomy. If you have “ball and socket” arthritis, you probably experience a deep pain in your shoulder, cramping, and decreased range of motion with clicking, popping and “strange” noises coming from your shoulder.
Figure 1 A healthy shoulder
Figure 2 An arthritic shoulder
Our first line of treatment for arthritis is physical therapy to strengthen your rotator cuff, deltoid and periscapular muscles. We may also offer you an injection of steroid and lidocaine into the ball and socket joint to reduce pain and improve your symptoms. Anti-inflammatories such as Advil (Ibuprofen) and Aleve (Naproxen) work well for shoulder arthritis.
When these above options stop working for pain relief and your normal every day activities are a burden, we then consider performing a total shoulder replacement for you. The one thing that is absolutely required to have a total shoulder replacement is that your rotator cuff is functioning normally. Many surgeons will obtain an MRI to confirm this before taking you to surgery. The total shoulder replacement is seen in figure 3.
Figure 3
Courtesy and reproduced with permission of Wright Medical and Tornier Aeuqalis Ascend Flex Shoulder Replacement
A total shoulder replacement. There is a metal component in the humerus with a metal “head.” The socket component is a highly engineered plastic that is cemented into the old socket after removing arthritis.
Reverse Shoulder Replacement:
The reverse shoulder replacement is another type of shoulder replacement that we use for patients that have one of three main shoulder problems.
1.) Advanced arthritis of the ball and socket WITHOUT an intact and functioning rotator cuff.
2.) Older patients with a complex proximal humerus fracture (fractures of the ball side of the shoulder joint) where healing of the fracture may not occur due to loss of vascularity to the bone or loss of the rotator cuff.
3.) Patients with chronic, long standing rotator cuff tears that cannot be repaired and where patients no longer can lift their arm.
In reverse shoulder replacement, we REVERSE the “ball and socket joint.” See figure 4. Why do we do this? The reverse shoulder replacement changes the mechanics of how the shoulder works. Because of the new dynamics we create after placing these components, the deltoid “shoulder” muscle does the work of the rotator cuff and allows you to move your shoulder normally. Therefore, the reverse shoulder replacement does not need an intact rotator cuff to function.
What can you expect after a reverse shoulder replacement? Your pain will be relieved and you will be able to move your shoulder almost back to normal except in full flexion above your head or full external rotation. We also will restrict the amount of weight that you lift to less than 10-20 lbs. after reverse shoulder replacement so that you do not wear out your components.
Courtesy and reproduced with permission of Wright Medical and Tornier Aeuqalis Ascend Flex Shoulder Replacement
Figure 4 A reverse shoulder replacement. A metal component is placed in the humerus and and metal baseplate is placed into the old socket. We then place a ball in the socket and a highly engineered plastic component acts as the joint between the metal in the humerus and the ball in the socket.
What to Expect Before Surgery:
Before surgery you will receive pre-operative testing to make sure that you are medically fit for an operation. During the time before surgery, you should try to make yourself as healthy as possible! Eat well, hydrate, exercise and be happy! Taking care of yourself before surgery will make healing and getting back to normal much easier.
The Surgery:
Both a total shoulder replacement and reverse shoulder replacement take about one to two hours depending on your anatomy. Right before surgery you will meet an anesthesiologist who will be with you and monitoring you during the entire surgery. Any questions or concerns you have about anesthesia they will be happy to answer for you. They will also discuss giving you a “nerve block” of the shoulder that is being replaced. This allows you to wake up pain free and allows them to use less medication while you are in the OR.
You will awake in the post-anesthesia care unit with a sling on your arm. You will stay one night in the hospital and a team of nurses, case manager’s, APRN’s and physical therapists will make sure you are safe to go home and that you understand how to care for your dressing, incision and new shoulder! For some patients, this surgery can be done as an outpatient where you can go home the same day.
After Surgery:
Expect to be a little sore for a few days from the surgery, but each day gets a little better. Also, you will not be allowed to use the arm to lift anything while you heal for a few weeks. We are happy however if you take the sling off several times a day to move your elbow and if you are comfortable, let your arm hang and do small pendulums to relax your shoulder muscles (this feels good too!).
At two weeks, we will see you in the office to remove stitches and take x-rays. At this point you will be started in physical therapy to start some early range of motion to make sure you do not get stiff. We will see you again at 6 weeks and will usually progress you to lifting some light weight and actively moving your arm. Sometime between 6 and 12 weeks, depending on who your surgeon is, we will let you come completely out of your sling. By 6 months, your shoulder should feel pretty good and by one year, we hope you forgot you even had a shoulder replacement!
If you need a shoulder surgeon, myself and my colleagues at OrthoRI would be happy to talk to you in consultation. If you have x-rays, CT scans or MRI’s, please bring them to your visit so that we can evaluate them. Thank you for your time and feel free to reach out if you have any questions. We would be happy to see you in any of our offices in Westerly, Wakefield, East Greenwich, Warwick and Providence.
If you want more information on shoulder replacement, please see this brochure.
