Surgical Explanations
Rehabilitation Protocols
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Total Shoulder Replacement
Loss of the cushioning of the shoulder joint cartilage is often a slow and progressive process. Because we don’t walk on our shoulders, we can generally tolerate levels of shoulder osteo- and rheumatoid arthritis that might be unbearable in the weight-bearing hip or knee joints. Nevertheless, a time comes when simple tasks are difficult in the face of shoulder joint arthritis. X-rays will confirm the degree of arthritis, and an MRI is often recommended to study the soft tissues around the shoulder joint, particularly the rotator cuff.
Treatment options should always start with non-surgical measures. If appropriate, our clinic can provide a long-acting corticosteroid injection – an agent which decreases pain by quelling arthritis-associated inflammation.
Physical therapy provides a limited, but essential, role in identifying the strengths and weaknesses of a patient with shoulder arthritis. Patients can often improve function by strengthening the surrounding muscular assets of the shoulder joint.
Surgery for shoulder arthritis involves resurfacing the joint with metal and plastic. As cartilage wears away, nerve endings within the bones become exposed. A shoulder replacement decreases pain by eliminating contact between the exposed nerve endings. Simply resurfacing the head of the humerus (the ball part of the joint) can produce acceptable results. But outcomes are much better when care is taken to provide both a plastic socket (the glenoid component) at the same time of humeral head replacement, rather than just resurfacing. In this fashion, both surfaces are protected.
Total shoulder replacement surgery takes close to two hours of general anesthesia and 1-2 nights of hospital stay for pain control, observation, and standard post-surgical antibiotics. A shoulder immobilizer (sling) is provided for pain control and to take the tension off of the surgically reconstructed shoulder soft tissues for the first month. Physical therapy commences four weeks after surgery.
Patients who present with more complicated situations, such as a concurrent chronic rotator cuff tear, are not candidates for a standard total shoulder replacement procedures. In these cases, it is important to discuss other options; unfortunately, these are somewhat limited and may involve the reverse total shoulder replacement.
Universally, patients enjoy pain relief after total shoulder replacement. Basic activities of daily living become more easily tolerated. Moderately aggressive activities such as golf, light object lifting, or gardening are often improved. Overhead activity such as tennis or lifting objects above the head is achieved in some but not all patients. Although the final results depend on many factors, outcomes can be directly related to the patient’s effort during the 4-6 months following surgery. |
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