If you have a limited range of motion and are suffering from pain, it’s time to see a specialist. We provide effective surgical and non-surgical treatment options to get you back to enjoying your best life.
The shoulder joint is one of the most complex and large joints in the human body and can be affected by many conditions from bursitis to dislocation.
Due to anatomic and physiologic changes related to the aging process, the shoulder is among the more common joints affected by active lifestyles. The symptoms of pain and soreness can be the same, whether the problem is related to an old injury or degenerative conditions such as arthritis. Initially, pain may limit usage, but can progress to pain at rest and at night.
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There are three major types of arthritis including osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis of the shoulder.
Many patients tolerate arthritis of the shoulder joint fairly well and so the natural history of shoulder arthritis is not entirely known. It often begins with dull pain in association with motion or activity. Usually, it is a gradual onset and progresses slowly over time. Most patients then notice limited shoulder range of motion or stiffness with daily activities. Loss of motion may also be accompanied by a feeling of grinding, catching, clicking, or snapping within the shoulder joint. Weakness is usually due to pain inhibiting shoulder power. As shoulder arthritis progresses to an advanced stage, many patients will also experience pain that wakes them up at night.
You will undergo a physical exam and imaging, typically X-rays will be reviewed in the office. A history of progressive loss of motion and pain interfering with sports, work, and eventually, daily activities is a typical complaint of patients. Loss of sleep due to pain is also an important complaint we typically hear from patients. Crunching (crepitation), grinding sensations, and catching may also be symptoms the patient notices. Weakness may be present simply due to pain interfering with your ability to move your arm.
Imaging typically demonstrates joint space narrowing, sclerosis, osteophyte (bone spur) formation, and cyst formation. It may also demonstrate elevation of the humeral head (ball) in the joint which may indicate evidence of a large and/or chronic rotator cuff injury.
We initially trial nonoperative management with all patients. This conservative treatment may be effective in some patients to temporize the need for a shoulder replacement. These are listed below:
Activity Modification: This should be one of the first steps a patient takes, and sometimes simply eliminating some activities (like weight-lifting) markedly reduces pain.
Physical Therapy: This may be effective if flexibility can be restored to the shoulder; however, if there is severe joint irregularity and marked stiffness it may actually aggravate shoulder pain.
Anti-inflammatory medications: These are called NSAIDS (Non-steroidal anti-inflammatory agents) can be effective in some patients and there are many types of medications. Which is more effective is largely an individual patient issue as there is no real compelling evidence for one being better than the other. All of these may have side effects including stomach upset, internal bleeding, and other problems. Thus, it is important to consult your physician if you take these medications for an extended period of time.
Cortisone injection is a type of anti-inflammatory medication and it helps to reduce inflammation as it is directly injected into your shoulder joint. Injections of corticosteroids may give marked pain relief; however, this effect is usually limited and may last anywhere from a few hours to a few months. Repeated such injections raise the risk for infection or damaging effects of steroids to the rotator cuff tendons.
In our experience, patients will decide on shoulder surgery when they cannot sleep due to pain and their function has deteriorated so much that they cannot enjoy work activities and even daily living activities.
Total Shoulder replacement: In a normal, or “anatomic” total shoulder arthroplasty, the ball and socket of the shoulder is replaced to mimic the shoulder’s natural joint anatomy and mechanics. The humeral head or “ball” is replaced with a metal implant made of cobalt chrome and titanium which resembles the head’s native size and anatomy. The glenoid, or “socket” is replaced with polyethylene (plastic) that is similar in size and shape to the natural glenoid anatomy. This procedure is typically indicated for patients with arthritis of the shoulder that have intact, or normal, rotator cuff tendons.
Reverse Total Shoulder replacement: A reverse prosthesis (also known as reverse total shoulder arthroplasty, or reverse shoulder replacement) is a newer technology that utilizes a “non-anatomic” shoulder replacement in patients who have shoulder arthritis and are without normal rotator cuff muscles and tendons. This prosthesis can also be used as a salvage procedure for failed surgery (i.e. for revising a failed total shoulder replacement) or in older patients with severe fractures of the proximal humerus (shoulder) that may be beyond surgical repair (due to loss of bone or a large number of fracture pieces).
Preoperatively, you will likely undergo an advanced imaging study (CT or MRI) to better evaluate your shoulder anatomy and assist in operative planning.
Surgery will take place at one of our main hospitals (SLRMC, Lone Peak, or Davis Hospital). You will receive general anesthesia as well as a preoperative nerve block for additional pain control. Surgery typically lasts around 2 hours but may last longer if your case has higher complexity. You are then admitted to the hospital for 1-2 days and are discharged home.
You will meet with physical and occupational therapists in the hospital, and then visit with these specialists as an outpatient within the first 2-6 weeks after surgery. Your surgeon’s office will make these arrangements. Shoulder range of motion exercises will generally begin within the few first weeks after surgery, and strengthening exercises are initiated between 8-12 weeks after surgery. You will meet with your surgeon and care team several times in the first few months after surgery to ensure you are progressing appropriately.
You should plan to protect the arm in a sling for approximately 4 weeks after the surgery, which means that help may be needed with daily chores, transportation, and other activities of daily living. Plan ahead for assistance from a friend, family member, or professional caregiver.
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