When there is wear and tear in the shoulder joint it is described as arthritis of the shoulder joint. The disease process can be mild to severe. They can lead on to pain and stiffness of the shoulder joint. Hence there is limitation of shoulder function and the quality of life can be affected.
In a normal shoulder, the rounded end of the upper arm bone (head of the humerus) glides against the small dish-like socket (glenoid) in the shoulder blade (scapula). The surface of the joint normally is smooth and shiny and this helps us to perform free movement without much resistance and very low friction. Shoulder is one of the joint in the body that has very high mobility. In arthritis there is loss of this glistening surface of the joint and hence the underlying bone gets exposed. This leads on to pain, clicking, creaking sensation during movement and also reduced range of motion of the shoulder joint.
The common mode people get arthritis in the shoulder joint is part of ageing. Hence this condition is seen in elderly population and this is generally related to the usage of the arm over the course of the life. Previous fracture around the shoulder joint also can predispose to arthritis of the shoulder joint. A group of muscle that surrounds the shoulder joint called rotator cuff muscles if not functioning then that can also predispose to a different type of arthritis called CUFF TEAR ARTHROPATHY.
Inflammatory conditions of the joint such as Rheumatoid Arthritis, gout etc can also result in severe pain of the joint. Rarely sudden lack of blood supply to the humeral head can result in longstanding arthritis.
Patients with arthritis typically describe a deep ache within the shoulder joint. Initially, the pain feels worse with movement and activity, and eases with rest. As the arthritis progresses, the pain may occur even when the shoulder is at rest. Eventually, the pain worsens so that it can disturb the sleep in the night. The patient’s shoulder may make grinding or grating noises when moved. Over the time, shoulder becomes stiff and painful to move. Simple daily activities like reaching into a cupboard, dressing, toileting and washing the opposite arm pit may become increasingly difficult.
The diagnosis is done by physical examination and investigations such as X ray. Sometimes a CT scan may be needed if we are planning for a total shoulder replacement.
Initial treatment starts with taking pain-killing tablets. Gentle exercises to the shoulder will improve the stiffness. This simple measure can be helpful in early stages. An injection into the shoulder joint with a corticosteroid and local anaesthetic can also give short-term pain relief. But if the pain continues and affects the quality of life, disturbs sleep in the night and limits the activities to a considerable extent, then a surgery to replace the shoulder joint.
Total shoulder replacement can dramatically improve the pain, get mobility of the shoulder joint and the quality of life would improve.
If the shoulder joint is worn leading on to severe pain, an artificial joint can be implanted and this is called Total shoulder replacement. A satisfying function and good pain relief can be achieved after performing total shoulder replacement. If no complications occur, more than 95% of the time a shoulder replacement can last for more than 10-15 years.
The procedure is done for those suffering from advanced arthritis of the shoulder joint. Total shoulder replacements are also performed for fractures of the upper end of arm bone. In fractures, usually it is such a situation that the fixation is not possible as the fracture is complex.
The choice of procedure depends on number of factors. A severely destroyed humeral head and glenoid surface with well working rotator cuff muscles would require a Anatomic Total Shoulder Replacement. If the rotator cuff muscles are not functioning and a person has got severely damaged shoulder joint, then Reverse polarity Total Shoulder Replacement will be the correct option. In reverse total shoulder replacement, the socket and metal ball are switched. That means a metal ball is attached to the shoulder blade bone and a plastic socket is attached to the upper arm bone. This gives a biomechanical advantage by changing the centre of the rotation of the shoulder joint and also tensions the arm muscle called deltoid. These factors allow using the deltoid muscle instead of the torn rotator cuff to lift the arm thus facilitating to regain the lost movement.
If the destruction of the humeral head is not severe and hence if adequate bone stock is available, then Resurfacing arthroplasty of the shoulder joint will be the option. The above description gives a general outline. Shoulder replacement surgery is highly technical. Each case is individual. The situation will be carefully evaluated before making any decisions. The correct nature of procedure will be determined after physical examination and performing radiological investigations such as X ray and CT Scan.
You will be anaesthetized for the surgery. Hence you would have some blood tests and routine check up by an anesthetist for the surgery. The intensity of the pain in first 24 hours is high. Hence during the surgery you will also have an injection to block the nerve supply of the arm. This block helps to get the whole arm numb and you feel a very little pain after the surgery. A physiotherapist will see you before the surgery and teach you on the exercises that you will have to carry on after the surgery.
An inpatient stay in the ward for 2-3 days may be essential to optimize pain and train for getting range of motion before discharge. An adequate pain relief will be provided, wound will be checked, and an X ray of the shoulder joint will be taken. A physiotherapist will teach the exercises that need to be carried on to get satisfactory function. When discharged, a plan of home exercise programme will be taught.
The success of the surgery is very high. It is in the order of 90-95%. Most of the patients are satisfied with pain relief and gain of mobility.
The complications after the surgery are minimal. Infection, Nerve injury, Dislocation and Fracture are the important complications to think about, but fortunately the incidence of these problems is low
A careful, well-planned rehabilitation program is critical to the success of a shoulder replacement. A sling will be given for comfort during the first four weeks. Most patients are able to perform simple activities such as eating, dressing and grooming within 2 weeks after surgery.
Here are some “do’s and don’ts” for when you return home:
Many thousands of patients have experienced an improved quality of life after shoulder joint replacement surgery. They experience less pain, improved motion and strength, and better function.
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