SHOULDER ARTHRITIS AND REPLACEMENT
According to the American Academy of Orthopedic Surgeons, about 4 million people in the United States seek medical care each year for shoulder problems. These conditions range from injuries such as dislocations and fractures to chronic, debilitated diseases like arthritis.
Shoulder replacement surgery has been available to patients with severe, chronic, debilitating arthritis since the early 1960s. Like other joint replacement surgeries, it is designed to removed diseased portions of bone and joint and replace them with a combination of metal and plastic components. Thereby reducing the friction caused by disease and improving range of motion, eliminating the associated pain.
Shoulder replacement surgery cannot create a normal joint in place of an arthritic one, but it can allow you to have a greater range of motion without pain and allow you to return to a more normal schedule of activities.
"I feel a lot better than, than I did before. I can do about everything I used to do. You know without the pain that I had before."
The shoulder joint is a complicated mechanism, made up of several bones and muscles, all working together to provide an incredible range of motion and stability.
Let's take a closer look at exactly what structures are involved in providing that support. The shoulder joint is sort of a ball and socket joint. The top of the humorous or upper arm bone widens and is made up of the head of the humorous. These head then fits into a shallow socket of the scapula or shoulder blade and is called the glanoid fascia.
The parts of the head and socket that touch are covered by articular cartilage. The cartilage covers the head of the humorous as well as the surface of the glanoid fascia of the scapula. In a healthy joint, this cartilage protects the bones against friction during movement. In addition, a cartilage rim surrounds the peripheria of the glanoid fascia and provides a slightly deeper socket for the humeral head to rest in. The joint capsule surrounds the joint and is filled with synovial fluid, which also aids in reducing friction.
During motion, the humeral head moves in the glanoid fascia providing a wide range of motion. Because of the fit between these two bones however, very little surface area of the bones are actually in contact at any given moment.
The stability of the joint primarily relies on the joint capsule and a set of short muscles that wrap around the shoulder, keeping the humorous from slipping out of the socket. There are four muscles that come together to form a flat tendon known as the rotator cuff. The tendons of the rotator cuff cover the head of the humorous and help stabilize the shoulder by connecting the humorous to the scapula.
The primary muscle for power movement of the shoulder is the large deltoid muscle, which creates the bulk of muscle about the shoulder. In a normal shoulder, these parts all work together to provide stability during an incredible range of motion. The cartilage-covered surfaces of bone are smooth and shiny, allowing each to move against the other with minimal friction.
When any of these surfaces become diseased however, the normally smooth surface becomes rough, causing friction and pain. Arthritis causes the cartilage to break down, causing the bones to rub against each other. When this happens, scar tissue and bone spurs may also develop which leads to further pain and stiffness. Many different conditions can affect the shoulder and lead to a discussion regarding total shoulder replacement.
Some of these conditions include rheumatoid arthritis, osteoarthritis, rotator cuff arthropothy, a vascular necrosis, old fractures of the shoulder region or a failed shoulder prosthesis from a previous joint replacement. The most common reason however is arthritis.
In shoulder replacement surgery, first the surgeon will make an incision along the front of the shoulder, diagonally from the clavicle, the collarbone, to the middle of the upper arm bone. This allows the surgeon to gain access to most of the joint and to perform the procedure without causing damage to the large deltoid muscle of the shoulder.
Then bones must be prepared to accept the prosthetic parts. The humorous is cut and reshaped, and the prosthesis is placed in the bone. The humeral head component consists of a smooth metal ball attached to a stem that is inserted down into the humorous. If the glanoid fascia is smooth and not eroded, the surgeon may elect to only insert the humeral prosthesis.
This is known as a hemi arthoplasty shoulder replacement. However, if the glanoid fascia and the scapula is flatten and eroded, then the surgeon will likely reshape the glanoid and then insert the plastic glanoid prosthesis.
This is then known as a total shoulder replacement. Finally, the subscapularis tendon is firmly repaired back to the humorous with heavy sutures. Since the surgery has been done with minimal soft tissue detachment, only the detachment and the repair of the subscapularis tendon is necessary.
The rehabilitation program can begin within a day or two of the surgery. The patient will be instructed in a graduated rehabilitation program, which will first restore motion to the shoulder, and then at 4 to 6 weeks will begin a progressive strengthening program.
"I only took pain pills a couple of days after surgery and I don't take anything now, not for this shoulder, no."
As with any surgery, you must weigh the risks and potential benefits and decide whether or not to have the surgery performed. Because this is not a life or death decision, it is solely your decision to make.
Some of the potential risks include injury to nerves and blood vessels, stiffness or instability of the shoulder joint, loosening of the prosthetic parts requiring additional surgery, tearing of the rotator cuff tendon, fracture of the humorous.
In addition, total shoulder replacement carries with it the normal risks of any elective surgery including risks of anesthesia including death, excessive bleeding, blood clots, infection. You should carefully consider these risks along with the possible advantages of the surgery and weigh them carefully.
Because the rehabilitation process requires so much effort on your part, it is important that you have a positive attitude if you decide to have the surgery. Therefore, the decision cannot be a reluctant one. Only you will live with the results. A successful shoulder replacement can mean a return to activity that you may have given up because of pain, but only after a recovery process that will require a great deal of work and rehabilitation.
"I couldn't sleep and I have really no problems at all sleeping anymore. The shoulder doesn't wake me up like it used to."
DynoMed.com, LLC, as the executive producer of this videotape, does not practice medicine, does not recommend this or any other surgical technique for use on a specific patient, and does not guarantee the results of any particular surgical technique. Each patient should consult a physician for determining the necessity of surgery, and for the determination and utilization of the appropriate surgical techniques.
Images from LifeArt®, 3D Super Anatomy, 1998
Lippincot, Williams, and Wilkens
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