Total Shoulder Replacement - Shoulder Arthroplasty
Arthritis is a common disease that causes joint pain, stiffness, and swelling. It affects the cartilage in joints. Cartilage is a very tough, shock absorbing material that covers the ends of many of our bones. The cartilage forms a smooth surface and allows the bones in our joints to glide easily during motion. Arthritis can cause the cartilage to wear away. Loss of the protective lining can cause painful bone on bone rubbing.
Severe shoulder arthritis can be quite painful and can cause restriction of motion. While the symptoms of shoulder arthritis may be tolerated with some medications and lifestyle adjustments, there may come a time when surgical treatment is necessary. Shoulder replacement surgery, also called Arthroplasty, involves the replacement of the damaged bone and cartilage with metal and plastic implants. Shoulder Arthroplasty is a treatment option that can relieve pain and restore function. Very often, people tolerate their symptoms for long periods of time because the arm is not a weight bearing extremity. For this reason, arthritis of the shoulder is not as common as in the hip and knee. As such, most people know someone who has had a hip or knee replacement, but many people do not even know that shoulder replacement is an option.
The glenohumeral joint is not a true ball-in-socket joint like the hip, but it is similar in structure. The top of the humerus is round like a ball. It rotates in a shallow basin, called the glenoid, on the scapula. A group of ligaments, called the joint capsule, hold the ball of the humerus in position. Ligaments are strong tissues that provide stability. In other words, the joint capsule is responsible for holding our arm in place on our body.
Several ligaments connect our shoulder bones together. Tendons attach our muscles to our bones. Our muscles move our bones by pulling on our tendons. They move our arms to position our hands for a variety of functions. The shoulder also provides stability when our elbow flexes as we lift objects.
The Rotator Cuff tendons connect strong muscles to the humerus bone. These muscles allow the arm to rotate and move upward to the front, back, and side. A fluid-filled sac, called the subacromial bursa, lubricates the rotator cuff tendons allowing us to perform smooth and painless motions. We use the rotator cuff muscles to perform overhead motions, such as lifting up our arms to put on a shirt, comb our hair, or reach for an item on a top grocery shelf. These motions are used repeatedly during sports, such as pitching in baseball, serving in tennis, and passing in football.
Osteoarthritis is the most common type of arthritis, affecting some 21 million Americans alone. It tends to develop as people grow older. Osteoarthritis can result from overuse of a joint during sports or work. Post-Traumatic Arthritis can develop in individuals of all ages after a shoulder injury, such as a fracture.
Osteoarthritis causes the cartilage covering the end of the bones to gradually wear away, resulting in painful bone on bone rubbing. Abnormal bone growths, called spurs, can grow in the joint. The bone spurs add to the pain and swelling, while disrupting movement.
Some people that have had a rotator cuff injury for a long time may develop Rotator Cuff Tear Arthropathy. This condition results from the changes in the shoulder joint that occur because of the rotator cuff tear. Eventually, arthritis can develop, which leads to destruction of the joint cartilage.
Shoulder Replacement Surgery is also a treatment for Avascular Necrosis. This medical condition causes a lack of blood flow to the head of the humerus bone, causing it to die. Avascular Necrosis can be caused by several factors, including chronic steroid use, deep sea diving, severe fractures, sickle cell disease, and heavy alcohol consumption.
Your physician will order X-rays to see the condition of your shoulder bones and to identify areas of arthritis or bone spurs. Sometimes your doctor may order Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) scans to get a better view of the bone and soft tissue structures. These imaging tests are also painless. They require that you remain very still while a camera takes images of your shoulder joint. CT scans provide a view in layers, like the slices that make up a loaf of bread. MRI scans provide the most detailed images of the tendons and ligaments.
Total Shoulder Replacement Surgery is recommended for people with bone-on-bone Osteoarthritis and intact rotator cuff tendons. This is the most common type of shoulder replacement surgery. Your surgeon will make an incision, approximately six inches long, on the front of your shoulder joint. Your surgeon will replace the damaged head of the humerus with a highly polished metal ball. The metal ball may be surgically implanted in the humerus or attached with surgical cement, depending on the condition of the bone. The glenoid is replaced with a plastic socket.
In some cases, the surgeon may only replace the head of the humerus in a procedure called a Hemiarthroplasty. This procedure is used if the glenoid cartilage is in good condition.
A Hemiarthroplasty is commonly used to treat shoulder fractures.
A Reverse Total Shoulder Replacement Surgery is recommended for people with completely torn rotator cuffs, severe arthritis with cuff tear arthropathy, or prior failed shoulder surgery. Traditional total shoulder replacement would still leave these individuals with pain and the inability to lift their arms above their shoulders. In a Reverse Total Shoulder Replacement Surgery, the ball and the socket are switched. The metal ball is attached to the scapula, and the socket is attached to the end of the humerus. This allows the deltoid muscles, instead of the damaged rotator cuff muscles, to lift the arm above the shoulder.
Another form of replacement is resurfacing Arthroplasty, when the cartilage is removed from the humeral head and a metal "cap like" prosthesis is placed over it.
Occupational or physical therapists can help you strengthen the muscles surrounding your shoulder joint. Your therapists may also apply heat treatments to help ease your pain and stiffness. Aquatic therapy in a heated pool may help relieve pain and stiffness, while providing you with gentle support while you exercise. Your therapists may recommend ways for you to do your daily activities, such as housework and meal preparation, in a manner that puts less stress on your shoulder.
Shoulder Arthroplasty is recommended when non-surgical treatments have provided minimal or no improvement of your symptoms. If you receive surgery, your surgeon will restrict some arm movements for a short period of time following your procedure. You will wear an arm sling for some period of time after surgery. An occupational or physical therapist will help you gently move your arm starting on the first day following your surgery, or on the day of surgery. You will gradually work towards moving your arm independently. You will learn exercises to strengthen and increase the movement in your shoulder. When your incisions are healed, you may participate in aquatic therapy. The heated pool environment may help relieve pain and stiffness while providing gentle support while you move your joints. Eventually, your therapists will provide you with a home exercise program.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.
The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.