Shoulder pain is an extremely common complaint from patients, and there are many common causes of this problem. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause.
Osteoarthritis is the most common type of shoulder arthritis. Also called wear-and-tear arthritis or degenerative joint disease, osteoarthritis is characterized by progressive wearing away of the cartilage of the joint. As the protective cartilage surface of the joint is worn away by shoulder arthritis, bare bone is exposed within the shoulder.
Shoulder arthritis can affect the shoulder joint (gleno-humeral joint), or the Acromioclavicular joint between the clavicle (collarbone) and acromion (shoulder-blade).
Both osteoarthritis and inflammatory arthritis can affect these joints, leading to pain and stiffness.
Shoulder arthritis symptoms tend to progress as the condition worsens. What is interesting about shoulder arthritis is that symptoms do not always progress steadily with time. Often patients report good months and bad months, or symptom changes associated with weather changes. This is important to understand because comparing the symptoms of arthritis on one particular day may not accurately represent the overall progression of the condition.
Although shoulder joint replacement is less common than knee or hip replacement, it is just as successful in relieving joint pain.
If nonsurgical treatments like medications and activity changes are no longer helpful for relieving pain, you may want to consider shoulder joint replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain and help you resume everyday activities.
The shoulder joint has the largest range of motion as compared to all other joints in the body.
The shoulder is made up of three bones:
The shoulder is a ball-and-socket joint between the scapula and humerus.
The ball, or head, of the upper arm bone, fits into a shallow socket in the shoulder blade. This socket is called the glenoid.
In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis.
The treatment options are either replacement of just the head of the humerus bone (ball), or replacement of both the ball and the socket (glenoid).
When the head of the upper arm bone is shattered, it may be very difficult to put the pieces of bone back in place. In addition, the blood supply to the bone pieces can be interrupted. In this case, a surgeon may recommend a shoulder replacement. Older patients with osteoporosis are most at risk for severe shoulder fractures.
An evaluation with an orthopaedic surgeon consists of several components:
As with all surgeries, there are a number of things that the hospital will ask you to do to contribute to the success of the operation.
Simple changes in your home before surgery can make your recovery period easier. For the first several weeks after your surgery, it will be hard to reach high shelves and cupboards. Before your surgery, be sure to go through your home and place any items you may need afterward on low shelves. When you come home from the hospital, you will need help for a few weeks with some daily tasks like dressing, bathing, cooking, and laundry.
The procedure to replace the shoulder joint with an artificial device usually takes about 2 hours.
The major types of artificial shoulder replacements are:
A cemented prosthesis is held in place by a type of epoxy cement that attaches the metal to the bone. An uncemented prosthesis has a fine mesh of holes on the surface. The bone grows into the mesh. Over time, this anchors the prosthesis to the bone.
Both types of artificial joints are widely used. Your surgeon may also use a combination of the two types. The surgeon determines the type of replacement joint based on your age, your lifestyle, and the surgeon’s experience.
Each prosthesis (artificial joint) is made up of two parts. The humeral component replaces the humeral head or the ball of the joint. The glenoid component replaces the socket of the shoulder, which is actually part of the scapula.
The humeral component is made of metal. The glenoid component is usually made of two parts. A metal tray attaches directly to the bone, and a plastic cup forms the socket. The plastic is very tough and very slick, much like the articular cartilage, it is replacing. In fact, you can ice skate on a sheet of this plastic without causing it much damage.
In reverse shoulder replacement, the ball and socket are reversed; the ball is placed on the shoulder blade and the socket is placed on the top of the arm bone. This reverse technique allows better function with there is a non-functioning rotator cuff.
Total shoulder replacement surgery alleviates pain by replacing the damaged bone and cartilage with a metal and plastic implant. The shoulder joint is a ball-and-socket joint, much like the hip joint. The ball is the top of the arm bone (the humerus), and the socket is within the shoulder blade (scapula). This joint allows people an enormous range of motion at the shoulder.
When shoulder replacement surgery is performed, the ball is removed from the top of the humerus and replaced with a metal implant. This is shaped like a half-moon and attached to a stem inserted down the center of the arm bone. The socket portion of the joint is shaved clean and replaced with a plastic socket that is cemented into the scapula.
After surgery, the patient is moved to the recovery room where the patient stays for several hours monitored by an anesthetist.
Antibiotics are given to prevent infection.
Most patients are able to eat solid food and get out of bed the day after surgery.
Patients are most likely to be able to go home on the first, second, or third day after surgery.
Pain Management-Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics, or a combination of these medications is used to improve pain relief.
Physical therapy will begin soon after surgery, and when you feel less pain, you can start moving sooner and get your strength back more quickly.
A careful, well-planned rehabilitation program is critical to the success of a shoulder replacement. Gentle physical therapy is started soon after the operation. Your surgeon will provide you with a home exercise program to strengthen your shoulder and improve flexibility.
Many patients have experienced an improved quality of life after shoulder joint replacement surgery.
Chairman & Executive Director
Elite Institutes of Orthopaedics & Joint Replacement
Paras Hospitals, Panchkula | Ivy Hospitals, Punjab
Formerly:
Director & Head Orthopaedics – Fortis Hospital- Mohali, Amritsar
Director & Head Orthopaedics – Max Hospital- Mohali, Bathinda, Dehradun
