A painful, immobile shoulder can make it difficult to perform daily tasks and prevent you from enjoying activities you once loved. The pain may be persistent, keeping you from getting a full night of sleep and impacting your overall quality of life. While some individuals find relief from shoulder pain with analgesics and simple exercises, others require surgical treatment to reduce the discomfort and restore range of motion in this joint.
Shoulder replacement has been used for decades to treat shoulder conditions that no longer respond to traditional therapies like medication and exercise. As many as 53,000 shoulder replacements are performed in the U.S. each year, according to the American Academy of Orthopaedic Surgeons. While that does not compare with the 900,000 knee and hip replacements that are done annually, plenty of adults are finding significant relief and restoration of their daily routines through shoulder replacement surgery.
When it is healthy, the shoulder allows for a greater range of motion than any other joint in the body. It is large and structurally complex, consisting of the top of the upper arm bone, known as the humerus, the scapula (shoulder blade), and the clavicle (collarbone). The scapula provides support and connects the shoulder to the collarbone, which acts as a strut to provide stabilization and allow the arm to hang freely. At the end of the scapula is the glenoid, a shallow cavity into which the head of the humerus fits to form one of the main shoulder joints, much like a ball and socket.
Articular cartilage covers these bony areas to offer protection and reduce friction. A membrane covers the remainder of the bony surfaces and produces a small amount of fluid that keeps the cartilage well-lubricated. Other key structures include the ligaments, tendons and rotator cuff, which work together to absorb stress and allow for smooth movement.
Over time, the joint cartilage can begin to deteriorate through normal wear and tear. It can also get damaged by accidents, injuries or sports-related trauma. As the cartilage breaks down, it allows the bone to grind against bone, leading to symptoms like pain, stiffness and reduced mobility. Other causes of shoulder pain include tears of the tendons, ligaments or rotator cuff, as well as fractures to the bone. If the damage is too extensive to treat with nonsurgical treatments like medication or exercise, a shoulder replacement can provide symptom relief and help restore your strength, function and range of motion.
Shoulder pain and loss of mobility can happen for a number of reasons, such as injury, trauma or normal wear and tear. Some common conditions that can damage the joint and lead people to seek shoulder replacement surgery include:
Osteoarthritis, also called wear-and-tear arthritis, is a gradual deterioration of the articular cartilage that protects the ends of bones and ensures smooth joint movement. Symptoms include joint pain and stiffness that worsen over time. Osteoarthritis is associated with certain risk factors, including aging, obesity and repetitive or forceful movements. Sports-related or occupational injuries like sprains, fractures or dislocations can also play a role.
Rheumatoid arthritis is a chronic inflammatory disease that affects the joints and damages healthy cartilage. It occurs when the immune system attacks the body’s own tissues, causing painful swelling that eventually leads to bone erosion and joint deformity. Rheumatoid arthritis is a progressive condition that results in worsening pain, stiffness and loss of mobility. It often starts in the smaller joints but can also affect one or both shoulders.
One of the primary functions of the rotator cuff is to keep the shoulder stabilized in the ball-and-socket joint. When the rotator cuff is torn after injury or trauma and not repaired, it can lead to bigger tears that compromise its ability to provide support. This can affect the alignment of the shoulder and make the joint wear out faster, causing a type of arthritis known as rotator cuff tear arthropathy. This condition develops slowly, over several years.
Avascular necrosis is a condition that occurs when bone tissue dies due to poor blood supply. It often affects the hips, knees and shoulders. Broken bones or dislocated joints can interrupt blood flow and cause this condition to occur, but excessive drinking, long-term use of corticosteroids and certain diseases are also risk factors. Over time, avascular necrosis can cause the bone to collapse. It can also alter its smooth shape and lead to severe arthritis.
Fractures of the shoulder bones can cause severe pain and limit your range of motion. They are often caused by injury or trauma and may also harm the surrounding joints, ligaments and tendons. While some fractures can be treated by immobilizing the arm to allow the bones to heal, severe cases might require shoulder replacement surgery to repair the damage.
Your doctor may recommend shoulder replacement surgery if you’re experiencing significant pain or loss of mobility that interferes with your daily life, especially if nonsurgical treatments like medication or physical therapy haven’t been effective. Many conditions that affect the joints are progressive, but shoulder replacement surgery can repair the damage to restore your strength and improve your ability to perform normal activities.
If you’re considering shoulder replacement surgery, you may be a good candidate for this procedure if you have:
Ultimately, whether you’re a candidate for shoulder replacement surgery will vary depending on several factors, including your overall health, symptoms and medical history. During your evaluation, your doctor will perform a physical examination to assess the motion, strength and stability of your shoulder. Other tests, including an x-ray or MRI, may also be used to determine the condition of the shoulder bones and soft tissues.
Your surgeon will perform your shoulder replacement under general anesthesia, and will most likely utilize a nerve block as well. The nerve block uses local anesthesia that numbs your entire shoulder and arm from the neck down. The nerve block reduces the need for general anesthesia by about 50% and helps control postoperative pain. The surgeon will make an incision between the shoulder and chest muscle and then separate the two, so the components of the artificial joint can be put in their proper place.
The shoulder prosthesis consists of a metal stem that has a ball on one end and a socket composed of heavy-duty, biocompatible plastic. The stem is placed into the top of the humerus and is usually cemented in to make it more stable. The socket is cemented into the scapula. The tendons of the shoulder are used to hold the ball into place in the socket. In a reverse total shoulder arthroscopy, the ball and socket are flipped to restore strength when rotator cuff tears are identified.
You will spend one to two days in the hospital to receive attentive care. You will be given medication to reduce your discomfort and a sling to protect your shoulder. The sling is worn for two to six weeks, although it can be removed for bathing and physical therapy.
You will begin supervised physical therapy within seven to 10 days after your surgery, which will last for three months. You will also need to do the exercises at home to alleviate stiffness and restore range of motion to the joint. With rehabilitation, you may find you can resume many activities you were unable to do before your replacement surgery.
While the full results of shoulder replacement are not entirely predictable, the rate of patient satisfaction after this surgery is overall very high. Most of our patients enjoy pain-free movement of the joint within one year after surgery, which increases their mobility and their quality of life. To learn more about your options in shoulder replacement, contact the Orthopaedic Institute of Ohio today at 419-222-6622.
After surgery, many patients regain significant functionality of their shoulder and are able to resume daily activities without pain. Physical therapy can further improve your strength and range of motion. Although your results might vary depending on your health, age and lifestyle, you can expect a shoulder replacement to last between 15 and 20 years.
Physical therapy exercises are an important part of your recovery after shoulder replacement surgery. They can help alleviate any pain or stiffness and restore mobility to the joint. Physical therapy will also help you safely resume your normal activities.
As with any surgical procedure, there is some risk of infection or a reaction to the anesthesia. There is also a possibility of nerve or blood vessel damage, but our surgeons take the utmost care to ensure your health and safety during surgery. Overall, the rate of complications is extremely low following shoulder replacement surgery, but your doctor will explain the risks in more detail to help you make an informed decision.
Most patients can resume work and light activity 10 to 14 days after surgery. If your job involves more heavy lifting or physical exertion, however, it can take longer before you can go back to work, since certain movements will be restricted as your shoulder heals.
It’s recommended to seek help from a friend or family member once you return home, since it will be difficult to complete certain tasks right after surgery. You may need someone to assist you with household cleaning, daily chores, pet or child care, cooking and more while your shoulder is healing. Having things ready in advance can reduce the workload, so consider doing any laundry, yard work or meal prep before your surgery day to ensure a smooth recovery.