Understanding Shoulder Replacement

Mid Florida Ortho

Brushing your hair. Getting dressed. Carrying groceries. Sleeping through the night. These are just a few of the life basics that can be difficult without full use of your shoulder. Fortunately, there are many ways to treat shoulder pain, depending on the cause.

One option is shoulder replacement surgery. More than 70,000 patients choose it every year, and although nobody can guarantee a perfect outcome, shoulder replacement is designed to reduce pain, allow greater strength, and provide better movement.

Of course, having shoulder replacement is a serious decision that you should discuss with your doctor at length and think over carefully. This content may help answer some of your questions.

Why Does My Shoulder Hurt?

The shoulder is a ball and socket joint that is made up mainly of two bones. The ball portion of the joint is part of the upper arm bone (humerus). The socket portion is part of the shoulder blade. The ball fits into the socket, allowing the shoulder to move. The two bones rub together as the shoulder moves, and in a healthy shoulder, that movement is painless.

Unfortunately, over time, regular wear and tear or injury to the joint can result in significant pain. There are three common conditions that damage the shoulder:

• Osteoarthritis
• Proximal humeral fracture
• Rotator cuff arthropathy

Osteoarthritis

In a normal, healthy shoulder joint, the surfaces of the ball and socket bones are very smooth and covered with a tough, protective tissue called cartilage. The cartilage prevents direct contact between these bones and allows them to move smoothly over each other, without friction or wear on the bone surfaces.

The problems start when that cartilage is injured or worn away—which is actually the definition of osteoarthritis. The bones grind against each other, and that grinding hurts. Eventually, all that friction causes the bone surfaces to deteriorate. Unfortunately, there is no medication or treatment that will make damaged cartilage grow back.

Proximal Humeral Fracture

A proximal humeral fracture is just the medical name for a broken shoulder. (Specifically, it means a fracture of the upper arm at the shoulder joint.) The injury is especially common among older people who suffer from osteoporosis, which causes the bone to become more fragile over time—making it vulnerable to fractures caused by falls or direct blows, like a car accident.

Rotator Cuff Arthropathy

The rotator cuff is a group of muscles and tendons that holds the shoulder together and helps stabilize it and give it strength. Rotator cuff arthropathy is a combination of two types of damage—not only has the cartilage been damaged or worn away, the rotator cuff tendon that connects the muscle to the bone has also been severely worn or torn.

Treatments

Depending on the extent and cause of the shoulder damage, your orthopedic surgeon can recommend a variety of treatments, including oral medications or injections for pain and inflammation, physical therapy, and various types of surgery. But if those treatments have failed, or you aren’t a candidate for them, your doctor can help you determine if it’s time to consider shoulder replacement surgery.

What Is Shoulder Replacement?

It’s the same idea as having most things fixed—worn parts are taken out, and new parts are installed in their place. In shoulder replacement surgery, the parts of the bones that rub together or have been broken are replaced with metal and plastic parts.

The part that replaces the ball consists of a partial sphere made of metal. This partial sphere sits on top of a metal stem that fits down into the shaft of the upper arm bone.

The part that replaces the socket consists of an oblong plastic disk with a cupped surface, which lines the socket and replaces the damaged cartilage. The partial sphere fits into this cupped surface to re-create the joint.

Different versions of shoulder replacement surgery are available, depending on your situation. For instance, sometimes it may be necessary to replace only the ball portion of the joint. Your surgeon will advise what is best for you.

How Will I Know If I Should Have Shoulder Replacement?

Your orthopedic surgeon will perform a very thorough examination of your shoulder. This will include a check of the muscles and tendons to determine how much strength and range of movement you have.

In addition, your surgeon will take X-rays, a CT scan (computed tomography), or an MRI (magnetic resonance imaging), which will be used to further assess the condition of your shoulder joint. If you decide on shoulder replacement surgery, these images also will be used to help your surgeon select the best type and size of shoulder implant.

Based on the examination and tests, your surgeon will determine whether you are a candidate for shoulder replacement. Although widely available, shoulder replacement is a major surgical procedure and should be considered only when all other treatment methods have failed.

What Risks Are Involved?

It’s important to understand the risks involved. There are potential complications both during and after surgery. Generally, these include infection, blood clots, pneumonia, implant loosening, and nerve damage. Your surgeon can answer your specific questions about these risks.