Shoulder Arthritis
Shoulder arthritis is the condition when the articular cartilage coating of the glenoid (socket) and the humerus (arm bone ) has worn out. The cartilage provides a smooth surface for the shoulder to glide through a painless range of motion. When the cartilage is lost the smooth gliding is lost and inflammation occurs.
Shoulder arthritis can occur from general “wear and tearâ€, past trauma or surgery, loss of rotator cuff ( the shoulder muscle) function, or systemic arthritis such as Rheumatoid. The treatment should be aimed at the patient , their age, and their expectations. The initial visit will include a history of the pain, physical exam, and x-rays.
The initial treatment of shoulder arthritis should always be conservative. We treat the inflammation with NSAIDS, ice and sometimes cortisone injections. Physical therapy can assist in strengthening the shoulder muscles and helping with motion. A significant trial of this treatment may take 3-4 months. If the conservative measures are not successful then surgical intervention may be needed. At this point, detailed discussion about age, proper diagnosis, and proper surgery is needed.
If the patient is young or less than 50 years old, shoulder replacement surgery should be the last option. Sometimes debridement of the spurs and loose cartilage through the arthroscope may give temporary relief, but this does not restore normal cartilage function.
If the patient is greater than 50 years old shoulder replacement surgery may be indicated. Shoulder replacement requires resurfacing the the humerus and possibly the glenoid with metal and plastic. This is a major surgery. You would need a medical evaluation from your primary care provider which would include labs, ECG and urinalysis. Active infections including teeth, urinary tract , and skin problems should be excluded. Once the medical work-up is complete, surgery can be scheduled.
You should eat or drink NOTHING past midnight the night before your surgery. On the day of surgery , the anesthesiologist will discuss going to sleep and a regional block. The region block is a separate procedure that will provide pain control after surgery. This is similar to a spinal. The surgery is completed and the patient goes to the norma l hospital floor. A sling is used along with a cold pack. Pain and nausea control is crucial during the hospital stay. You should also be taking your normal meds. Patients usually stay 2 nights in the hospital.
Upon discharge, you will start PT immediately. This can be done at home for the first 3-4 weeks. The sutures will be taken out at the first post-op visit at approximately 10 days. The sling is worn for 4 full weeks. Complete recover y is usually 3-6 months.
Special procedures may be needed if the patient is young of the patient has not rotator cuff. If the patient is very young, a special resurfacing head may be used on the humeral side and with nothing or a lateral meniscal transplant on the glenoid side.
If the patient has no rotator cuff a bipolar arthroplasty or reverse total shoulder may be indicated. Your surgeon can discuss the options with you.
The key to success is patient compliance and surgical skill. The shoulder physicians at AOC have extensive experience in shoulder arthoplasty with excellent results. We provide specific care for specific problems.
