Though not as common as knee and hip replacement, approximately 53,000 Americans have shoulder replacement surgery each year.
Osteoarthritis, or degenerative arthritis, is a major reason for
shoulder replacements. Over time, joints become inflamed and can result
in severe pain and decreased range of motion. Rheumatoid arthritis,
rotator cuff tears, trauma and injury are also culprits of pain and
restricted movement which may call for a shoulder replacement for
Board-certified orthopaedic surgeon and fellowship-trained sports medicine physician, Wayne McGough, Jr., M.D. , performs total shoulder replacements at Andrews Sports Medicine & Orthopaedic Center.
Some patients will have severe pain in the shoulder with daily activities, loss of range of motion, pain sleeping on it at night and weakness. If you experience any of these, you should have a thorough evaluation of why you are having the symptoms. They can be caused by arthritis and loss of joint space, or by bone spurs or soft tissue damage, which have different treatments.
Non-surgical treatment options include cortisone injections, medication, physical therapy, ice or activity modification. Surgery is indicated when these treatments fail to ease shoulder pain.
Some rotator cuff tears can be fixed arthroscopically by repairing the tendon itself. Arthroscopic surgery is a minimally invasive outpatient procedure that is used in rotator cuff tears to anchor the torn tendon to its attachment on the humerus bone. Only a small incision is made and there is no need for any joint resurfacing. Most patients with isolated rotator cuff tears are candidates for this type of surgery.
Other times, the tendon tear has been there too long or the shoulder has had too much cartilage damage and a replacement is necessary. The decision is ultimately between you and your orthopedic surgeon.
Types of Total Shoulder Replacement Surgery
There are two types of shoulder replacement surgery: total shoulder replacement and reverse total shoulder replacement. The decision on which surgery should be performed is based on whether the patient has a healthy rotator cuff. This can be determined with an x-ray, physical exam and possibly an MRI.
Total Replacement Surgery
A standard total shoulder replacement prosthesis follows the normal anatomy of your shoulder. The damaged portion of the socket is removed and a plastic cup is fitted into the shoulder socket in the shoulder blade. The head of the humerous bone is removed and a metal ball is attached in its place. The rotator cuff muscles and tendons are needed to help the shoulder prosthesis function like a normal shoulder.
Reverse Shoulder Replacement Surgery
The socket and metal ball are switched in a reverse shoulder replacement. The metal ball is fixed to the socket and the plastic cup is fixed to the upper end of the humerus bone. The reverse method works best for patients with an unhealthy rotator cuff because it relies on different muscles, the deltoid instead of the rotator cuff, to position and move the arm. It is also recommended if the patient has had a previous shoulder replacement that was unsuccessful.
For either surgery, some patients are able to return home the same day, while others may require an average of one night in the hospital and may benefit from a short stay in a rehabilitation center. Our surgical staff will work with you to help manage your pain, as well as set up appointments with one our preferred outpatient rehabilitation providers. A well-planned rehabilitation program is vital to the success of shoulder replacement. It is important for patients to perform home exercises as well as two to three months of physical therapy either at an outpatient rehab facility or with a home healthcare physical therapist to successfully return to their desired activity level. The goal is to allow for greater range of motion. It is important to discuss what activities you can perform safely after a shoulder replacement with your surgeon.
At The Shoulder Center at Andrews Sports Medicine, our fellowship-trained non-surgical physicians and orthopaedic surgeons provide the most-advanced, comprehensive treatment solutions for injuries and disorders of the shoulder. To schedule an appointment, call (205) 939-3699.Request an Appointment Online
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