Pain, stiffness and loss of motion are symptoms people with shoulder arthritis deal with on a daily basis. Orthopedic Surgeon and Sports Medicine physician Bryan Warme, MD offers non-surgical and surgical treatment for people with shoulder arthritis including reverse total shoulder replacement.
The shoulder joint is a ball-and-socket joint where the top of the humerus (upper arm bone) is rounded like a ball and fits into a rounded socket on the shoulder blade. The joint is surrounded by muscles and tendons that form the rotator cuff that aids in movement of the arm and stabilizes the joint.
The main goals of shoulder replacement surgery are to improve the quality of life, relieve pain and improve the range of motion,” says Dr. Warme. “When evaluating a patient with shoulder arthritis, it is important to determine the condition of the rotator cuff to help in decide what treatment options are right for the patient.”
Evaluation is done through a physical examination and diagnostic imaging. The physical examination includes testing a patient’s range of motion and evaluating the strength of the arm. If a patient fails both of these tests, a CT scan or MRI may be ordered.
“Before I operate on a patient, I suggest that we try a more conservative approach treatment such as physical therapy or corticosteroid injections,” says Dr. Warme. “Sometimes this is enough to improve patients’ symptoms and relieve pain.”
For patients that have tried these methods and haven’t improved, shoulder replacement is the next treatment option.
“Shoulder replacement surgery is an excellent procedure when chosen for the right reasons,” says Dr. Warme. “If you are waking up on a nightly basis, have tried physical therapy or injections and the pain and loss of motion is affecting your quality of life it is time to operate.”
The most common procedure used for patients with osteoarthritis and an intact rotator cuff is the total shoulder replacement, which replaces both the ball and socket with metal pieces. Full range of motion is restored with a total shoulder replacement.
“The amount of bone in the socket is what determines the type of replacement needed. When there is low bone in the socket to re-attach to, I perform a hemiarthroplasty, which replaces the ball only,” says Dr. Warme. “Hemiarthroplasty is considered a partial shoulder replacement and can offer up to 50% pain relief.”
Patients with shoulder arthritis that is caused by a torn rotator cuff present with different symptoms, including migration of the humeral head and pseudoparalysis.
“Reverse total shoulder replacement surgery is done when the rotator cuff is deficient,” says Dr. Warme. “In this surgery the socket is placed where the ball was and the ball is placed where the socket was.”
Stability is improved by reversing the ball-socket design. The deltoid muscle is used to move the shoulder rather than the rotator cuff. 110 degrees of motion is restored after a reverse total shoulder replacement, meaning patients can now lift their arm to do things like wash their hair and open cupboards.
After surgery, patients must wear a sling that keeps the arm next to the body. They will immediately notice pain relief.
“Reverse total shoulder replacement has been the biggest progress for the treatment of shoulder arthritis in the last 10 years,” says Dr. Warme. “Shoulder replacement surgery is different from knees and hips in the sense that it could last up to 20 years because it is not a weight bearing joint.”
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To learn more about shoulder arthritis and shoulder replacement surgery, check out the following online articles: