What is arthritis?
The bone in joints is lined with a smooth tissue that helps the bones glide over each other and cushions the bones. This is called cartilage. When the cartilage is worn away, the bones no longer glide smoothly over each other, and they have lost their cushion. This is called arthritis. It is also called degenerative joint disease.
Arthritis is commonly associated with pain and joint dysfunction. The large joints, the hip and knee, commonly develop arthritis as patients age. The shoulder develops arthritis, but at a lower rate than the hip or the knee. Pain and inability to sleep from that pain are the most common reasons patients go to the shoulder surgeon when they have shoulder arthritis.
How can it be treated?
In the early stages, shoulder arthritis can be significantly treated with oral medications like Ibuprofen (Motrin), activity modifications, and exercise. In the later stages, injections of Cortisone into the joint can be very effective in treating the inflammation and pain of the arthritis.
Special Case for Shoulder Replacement : Arthritis Developing because of a Rotator Cuff Tear
Arthritis that develops as a result of a very large rotator cuff tear can also cause significant pain and dysfunction. Some patients are unable to lift their arm high enough to even comb their hair because the rotator cuff is so torn that it is not functioning. These patients can be treated with a special type of shoulder replacement called the reverse ball-and-socket. It is designed to allow patients to lift their arm above their shoulder.
It does so by using the deltoid to compensate for the ineffective rotator cuff. It is able to do so because the ball is reversed and placed on the glenoid and the socket is placed on the proximal humerus. When the deltoid contracts it rotates the socket around the ball.
When should I consider a shoulder replacement?
When the pain can no longer be treated with medicines or injections, it is time to consider having the joint replaced. This involves removing the rough arthritic surface of the ball and socket and replacing them a smooth metal and plastic surface.
What Can I Expect From A Shoulder Replacement?
Shoulder replacements are excellent at relieving the shoulder pain that comes from arthritis. In most patients, motion is also improved. They are as successful as hip and knee replacements.
The surgery for a shoulder replacement usually requires an overnight stay in the hospital. Often, the anesthesiologist will insert medicine to numb the nerves of the shoulder and prevent pain. This is called a regional anesthetic (interscalene or supraclavicular block). In some cases, a thin tube (like those used for epidural anesthesia) is inserted under ultrasound guidance next to the nerves of the shoulder.
The anesthesiologist then attaches a small pump that drips anesthetic to keep the nerves numb. This can prevent any pain for several days. Usually, you will be in a sling for three to six weeks.
ONLY pendulum exercises are permitted during this time.
The surgery requires detaching the front of the rotator cuff to get into the joint (subscapularis tendon). It is reattached at the end of surgery. This is essentially like a rotator cuff repair. Like a rotator cuff repair, it must be protected for three to six weeks, so it can start to heal and not come loose.
This is why exercises are limited for three to six weeks after surgery