Total shoulder replacement (TSR) is an option for persons who have severe arthritis of the shoulder joint. Severe shoulder arthritis is often painful, and can cause restriction of shoulder motion and reduces the ability to perform normal activities of daily living. Arthritis causes the normal smooth cartilage lining of the joint to erode and the protective layer between the bones is removed. This erosion results in painful bone-on-bone arthritis. Surgical intervention can often be avoided with physical therapy and simple treatments including medications and lifestyle adjustments, however there may come a time when surgical treatment is necessary.
Anatomy
The shoulder is comprised of three bones: the Humerus (upper arm bone), the Scapula (shoulder blade), and the Clavicle (collar bone). The shoulder is a ball-and-socket joint and the socket is called the glenoid. The surfaces of the bones are covered with a smooth substance that protects the bones and enables them to move easily called articular cartilage. All the remaining surfaces inside the shoulder joint are covered with a thin, smooth tissue called synovial membrane which lubricates the joint and reduces friction.
Degenerative Joint Disease or Osteoarthritis
Osteoarthritis is an age-related “wear and tear” type of arthritis occurring in people 50 years of age and older. Occasionally it is found in younger people, too. When the articular cartilage softens and wears away the bones then rub against one another resulting in stiffness and pain. There is no way to prevent the development of osteoarthritis, which is why it is the common reason people opt to have shoulder replacement surgery. Other causes for a total shoulder replacement are severe fractures, post-traumatic arthritis, rheumatoid arthritis, rotator cuff tear, avascular necrosis (bone dying/loss), and failed previous shoulder replacements.
Common symptoms of shoulder arthritis include:
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- Pain with activities of daily living
- Stiffness and limited range of motion of the shoulder
- Swelling and tenderness of the joint
- Grinding or catching in the joint with movement
How do you know if Shoulder Joint Replacement for You?
According to the Agency for Healthcare Research and Quality, approximately 53,000 people in the U.S. have shoulder replacement surgery each year which is compared to more than 900,000 Americans who have knee and hip replacement surgery per year. An orthopedic surgeon can perform an evaluation to determine what approach is best for your situation. The surgeon will review your medical history, perform a physical examination, and possibly perform X-rays, MRI or a bone scan to determine the condition of the bone and soft tissues of your shoulder. Before deciding on TSR, most surgeons will recommend a nonsurgical treatments like medications, physical therapy to strengthen the musculature around the shoulder, improve range of motion, and education on activity changes.
When conservative measures are no longer helpful for relieving pain, you may want to consider shoulder joint replacement surgery. The decision to have shoulder replacement surgery should be a cooperative one between you, your family, your family physician, and your orthopedic surgeon.
Would I benefit from a TSR?
People who benefit from surgery often have:
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- Loss of motion and/or weakness in the shoulder
- Severe shoulder pain that interferes with everyday activities, such as reaching into a cabinet, dressing, toileting, and washing.
- Moderate to severe pain while resting and may be severe enough to prevent a good night’s sleep.
Shoulder Replacement Surgery
Total shoulder replacement surgery alleviates pain by replacing the damaged bone and cartilage with a metal and plastic implant. The ball is removed from the top of the Humerus and replaced with a metal implant. This is shaped like a half-moon and attached to a stem inserted down the center of the arm bone. The socket portion of the joint is shaved clean and replaced with a plastic socket that is cemented into the shoulder blade. Complications are rare but like any major surgery can include infection, prosthesis problems, and nerve injuries.
Physical Therapy Rehabilitation
After surgery, a careful, well-planned physical therapy program is critical for successful rehabilitation. Physical therapy begins soon after the operation with gentle mobility, treatments for pain control, and management of the incision site. The physical therapist will progress your program based on the physicians protocol and they will provide you with a home exercise program to strengthen your shoulder and improve flexibility. Studies show joint replacement surgery with physical therapy is a safe and effective procedure to relieve pain and help you resume everyday activities.
If you are considering Total Shoulder Replacement, come see us for a free consultation to set up your post-surgery physical therapy. To request an appointment, click here, or call directly to one of our three locations during regular business hours:
Cool Springs: 615-224-9810
Shelbyville: 931-684-0027
Spring Hill: 931-489-2022
