Understanding Shoulder Arthritis
The shoulder is very flexible because it is a ball-and-socket joint made up of three bones: the shoulder blade (scapula), the collarbone (clavicle), and the upper arm bone (humerus). It moves your arm a variety of directions — in front, above, to the side, and behind your body. It is the most flexible joint in your entire body. This flexibility can make the shoulder prone to injury from overuse, repetitive motions, falls, or strain from excessive weight. Due to anatomic and physiologic changes related to the aging process, the shoulder is among the more common joints affected by active lifestyles. The symptoms of pain and soreness can be the same, whether the problem is related to an old injury or degenerative conditions such as arthritis. Initially, pain may limit usage, but can progress to pain at rest and at night.
Several conditions can cause shoulder pain and disability, and lead patients to consider shoulder joint replacement surgery.
- Osteoarthritis (Degenerative Joint Disease): This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people. The cartilage that cushions the bones of the shoulder softens and wears away. The bones then rub against one another. Over time, the shoulder joint slowly becomes stiff and painful. Unfortunately, there is currently no way to prevent the development of osteoarthritis.
- Rheumatoid Arthritis:This is an autoimmune disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthropathies.”
- Post-traumatic Arthritis: This can follow a serious shoulder injury. Fractures of the bones that make up the shoulder or injury of the shoulder tendons or ligaments may damage the articular cartilage over time, or the damage can be so severe that the bones cannot be put back together. This causes shoulder pain and limits shoulder function, and may require a shoulder replacement.
- Rotator Cuff Tear Arthropathy: A patient with a very large, long-standing rotator cuff tear may develop cuff tear arthropathy. In this condition, the changes in the shoulder joint due to the rotator cuff tear may lead to arthritis and destruction of the joint cartilage.
- Avascular Necrosis (Osteonecrosis): Avascular necrosis is a painful condition that occurs when the blood supply to the bone is disrupted. Because bone cells die without a blood supply, osteonecrosis can ultimately cause destruction of the shoulder joint and lead to arthritis. Chronic steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease, and heavy alcohol use are risk factors for avascular necrosis.
- Failed Previous Shoulder Replacement Surgery – Although uncommon, some shoulder replacements fail, most often because of implant loosening, wear, infection, and dislocation. When this occurs, a second joint replacement surgery — called a revision surgery — may be necessary.
Is Shoulder Joint Replacement for You?
There are several reasons to consider shoulder replacement surgery. Patients who benefit from surgery often have:
- Severe shoulder pain from arthritis that interferes with everyday activities, such as reaching into a cabinet, dressing, toileting, and washing.
- Moderate to severe pain while resting. This pain may be severe enough to prevent a good night’s sleep.
- Loss of motion and/or weakness in the shoulder.
- Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, or physical therapy.
Depending on the underlying cause of your shoulder arthritis, type of shoulder replacement is decided. The type of procedures performed at Vachhani Hospital include:
- Total Shoulder Replacement
- Shoulder Hemiarthroplasty (replace humeral head or “ball” only)
- Reverse Total Shoulder Replacement
Treatment options for shoulder, elbow and upper extremity pain during the early stages easily include non-surgical options such as injections and anti-inflammatory medications along with physical therapy.
More resistant pain symptoms may lead to further diagnostic testing by MRI. When surgery is recommended for the treatment of your shoulder arthritis, a type of shoulder replacement will likely be recommended. For younger patients with a healthy rotator cuff (four small muscles in your shoulder) a total shoulder replacement is the best option.
If the rotator cuff is injured and cannot be repaired, a slightly different operation called a reverse total shoulder replacement may be needed.
At Vachhani Hospital, we approach your diagnosis and education with open communication and shared decision-making. It is important that you are fully aware of all of the options that are available to you.
Shoulder Pre And Post Surgery
What to Expect Before Shoulder Replacement Surgery
Joint replacement can help relieve pain and enable you to live more active life. If you are deemed a good candidate for joint replacement and decide to have surgery, it is good to be prepared, both mentally and physically before surgery. Planning ahead for the challenges of surgery and recovery will help ensure a more successful outcome. Below are answers to some frequently asked questions before surgery:
- What tests are needed before surgery? Prior to shoulder replacement, you will complete a variety of tests such as x-rays, and ECG, and blood tests. These medical studies ensure that you are healthy enough for surgery and enable your providers to ensure the best care after surgery.
- What type of anesthesia will I receive? Most of our patients receive a general anaesthesia for shoulder replacement.
- What type of implant or prosthesis will be used? We use implants with a design that has been shown to have good long-term survival. We do not use any implants that have been recalled. If you want specific brand names please discuss this with your surgeon before surgery.
- How long will I stay in the hospital? Most patients stay in the hospital about 2 days following shoulder replacement.
- How long will my recovery take? Most patients will obtain almost full recovery by 3 months after surgery. By 3 months, you can except to return to your activities of daily living. If you have a sedentary job, you should be able to return to work within 3-6 weeks. More physical jobs often require more time off for recovery.
- How will my pain be managed after surgery? We use “multimodal” pain management, meaning that we use a combination of medications such as opioid analgesics, and anti-inflammatories as well as ice to control your pain.
- Do I need physical therapy before surgery? Formal physical therapy is not required before surgery, but it is advised to get in the best physical shape possible before surgery to lessen the change for complication and shorten your recovery time.
- What medications should I stop taking before surgery? You will stop all medications that thin your blood 3 days before surgery such as aspirin and clopidogrel.
- What if I smoke or drink alcohol? If you smoke, cut down or quit. Smoking affects blood circulation, delays healing and slows recovery. Eat a nutritious, well-balanced diet. If you drink, do not consume any alcohol for at least 48 hours before surgery. If you use any other types of controlled substances, tell your doctor. Narcotics and other drugs can cause complications and impact your surgery.
What to Expect After Shoulder Replacement Surgery
The day after surgery, you will begin working with physical therapy to become comfortable using your new shoulder. For the first 3 weeks after surgery you will be in the “healing” phase and will primarily keep your arm in a sling to allow for healing. After your check-up at 3 weeks, we will start more physical therapy.
Joint replacement is major surgery and your recovery will take several weeks, but there are steps you can take now to make your time at home safer and more comfortable:
- If you live alone or have special needs, consider going to a specialized rehabilitation facility after discharge from the hospital.
- Arrange for someone to drive you home from the hospital and stay with you for several days after your surgery. Do not drive until cleared by your surgeon.
- Place items that you use frequently within easy reach.
- Remove any throw or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
- Consider modifying your bathroom to include a shower chair, gripping bar, or raised toilet seat. Place items that you use frequently within easy reach so that you do not have to reach up or bend down.