| Most often, a shoulder arthroplasty is a surgical procedure designed to replace the damaged or diseased natural bone of the shoulder with a prosthesis made of metal and polyethylene. What is referred to as the shoulder joint is the connection between the humerus or upper arm bone and a cup-like depression in the scapula or shoulder blade called the glenoid. The glenohumeral joint is a ball-and-socket type joint, similar to that of the hip, that is capable of producing arm movement in virtually all directions. In a hemiarthroplasty, only the ball of the humeral head is replaced. In a total shoulder arthroplasty, both the ball of the humeral head and the socket of the glenoid are replaced.
Degenerative arthritis, such as osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis can cause irreparable bone erosion, particularly on the articular surface or area where the two bones are connected and move against one another. To date, arthroplasty is by far the most successful type of treatment for those individuals with arthritic involvement of the glenohumeral joint. |
Source: Medical Disability Advisor
| While performed less often than hip or knee replacement, shoulder replacement can restore quality of life for individuals with limited shoulder function due to chronic pain or mechanical dysfunction.
Although the primary indications for this surgery are pain, joint instability, and limited range of motion, pain relief is the primary goal. The procedure is performed to relieve pain and stiffness associated with degenerative osteoarthritis, rheumatoid arthritis, or trauma-related arthritis that has failed to respond to medical treatment.
Arthroplasty of the shoulder is a useful treatment for individuals of all ages with unremitting pain and loss of mobility due to arthritic involvement of the shoulder joint; however, individual age and extent of disease may determine which procedure and prosthetic device is most appropriate. Regardless of age, the individual must be motivated to follow through with a substantial physical therapy commitment and must be a good surgical risk.
If a patient suffers from humeral head osteonecrosis where the blood supply to the humerus is compromised they may benefit from arthroplasty with reduction and bone grafting according to a new study. |
Source: Medical Disability Advisor
| Total Shoulder Replacement: Initially, either general or local anesthesia will be administered. An incision running across the front of the shoulder from the middle of the collarbone (clavicle) to the middle of the arm bone (humerus) will be made. Scar tissue, which may limit movement, is then removed. The upper end of the humerus is cut using a saw; some of the removed bone may be used as a bone graft to assist with the placement of the implant (prosthesis). The shoulder blade is then prepared for the placement of the artificial socket.
The humeral and the glenoid component compose the shoulder replacement which can be implanted with or without cement. The metal humeral component is the portion that takes the place of the ball on the upper end of the humerus, and the glenoid component is the portion that takes the place of the scapula's socket. The plastic glenoid component articulates with the ball of the humeral component.
Core Decompression and Bone Grafting: Core decompression is a procedure where an incision is made on front of the shoulder, blunt dissection is performed, and then a cannulated reamer is put into the proximal humerus using fluoroscopy. This drills a hole or tunnel in the bone into which bone graft can be inserted.
After the individual awakens from either surgery, a bulky dressing will be on the affected shoulder. A drainage tube may be in place to drain excess fluid from the operative site. For the first few postoperative days, a continuous passive motion (CPM) machine may be used to move the shoulder in order to decrease the possibility of stiffness. The average hospital stay is 3 to 5 days. |
Source: Medical Disability Advisor
| Approximately 89% of individuals experience a reduction in pain following a total shoulder arthroplasty procedure (Azar 495). While the joint usually functions better than the pre-surgery diseased joint, it may not function as well as a healthy normal joint.
Range of motion and strength may also be improved by this procedure, but functional improvement is less predictable than pain relief. Increase in motion is dependent on many factors, including how long the motion had been lost and whether the rotator cuff tendons are intact. Often abduction and flexion do not exceed 90° after shoulder replacement.
Most individuals are very satisfied with their postoperative result. However, if a patient does not recover from arthroplasty or suffers from recurrences of dislocation of the shoulder, arthrodesis or fusion of the joint with a screw is indicated. Unstable or dislocating shoulder replacement patients achieve stability and pain relief with arthrodesis, but the near total loss of shoulder that results creates significant handicaps. Individuals with osteonecrosis who have arthroscopic bone grafting are usually pain free and able to lift their upper extremity to 160° following recovery from surgery. |
Source: Medical Disability Advisor
| Note on research and authorship Ideally rehabilitation for individuals with a shoulder replacement begins before surgery by assessing the individual's medical and social condition in order to determine what they might require postoperatively for a successful outcome. The main goal of the rehabilitation is to restore function by controlling pain, improving the range of motion and strength of the shoulder.
Individuals who undergo total shoulder arthroplasty require a specific rehabilitation process that begins in the hospital and continues in outpatient physical therapy (Boardman). After surgery the shoulder is immobilized for approximately 5 days, during which the individual maintains range of motion of the neck, wrist, and hand by actively moving these joints in all available directions. Occupational therapists can instruct in the use of special equipment for activities of daily living (ADL) and mobility. Modalities such as ice may be used to reduce swelling and pain, and when indicated, heat may be used to promote muscle relaxation (Braddom).
One goal of rehabilitation is the restoration of range of motion. After the period of immobilization, individuals wear a sling, which may be removed for exercise. Therapists begin passive and active assisted exercises after surgery according to the protocol of the surgeon. Special attention must be paid to avoid dislocating the prosthesis and to protect the surrounding soft tissue. Prior to discharge the individual is instructed in a home exercise program, which is continued well after discharge from supervised rehabilitation. When indicated, the individual can start active exercises to achieve optimal range of motion and strength.
Individuals may need to continue both the stretching and strengthening exercises for 1 year after surgery to ensure the restoration of functional strength and range of motion.
Additional information may provide greater insight into the rehabilitation needs of this population (Azar; Dahni). |
| FREQUENCY OF REHABILITATION VISITS | | Surgical (Recurrent Dislocation) | |
| Physical or Occupational Therapist | | Up to 24 visits within 12 weeks | |
|
| The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice. |
Source: Medical Disability Advisor
| As with all major surgical procedures, complications can occur. Complications associated with shoulder replacement include infection, loosening, dislocation, and nerve or blood vessel injury. |
Source: Medical Disability Advisor
| Individuals whose jobs require heavy lifting or strenuous activities involving the arm will need permanent reassignment to sedentary duties. Also, the individual will require time off to attend regular physical therapy appointments. |
Source: Medical Disability Advisor
| Azar, Frederick M., Phillip E. Wright, and . "Arthroplasty of Shoulder and Elbow." Campbell's Operative Orthopaedics. 10th ed. St. Louis: Mosby, Inc., 2003. 483-509.Boardman, N. D., et al. "Rehabilitation after Total Shoulder Arthroplasty." Journal of Arthroplasty 16 4 (2001): 483-486. PubMed. Jun. 2001. 25 Feb. 2005 <PMID: 11402412>. Braddom, Randolph L. Physical Medicine and Rehabilitation. 2nd ed. Philadelphia: W.B. Saunders, 2000. Dahni, Diane L., and Jay Smith. "Rehabilitation after Shoulder Arthroplasty." Joint Replacement Arthroplasty. Ed. Morrey Bernard. Philadelphia: Churchill Livingstone, Inc., 2003. |
Source: Medical Disability Advisor
| Feedback |
| Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must
include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment.
If you are seeking medical advice, please contact your physician. Thank you! |
Send this comment to:
Sales
Customer Support
Content Development
|
|
| |
|
|
|
|
|
This publication is designed to provide accurate and authoritative information in
regard to the subject matter covered. It is published with the understanding that
the author, editors, and publisher are not engaged in rendering medical, legal,
accounting or other professional service. If medical, legal, or other expert assistance
is required, the service of a competent professional should be sought. We are unable to respond to requests for advice.
Any Sales inquiries should include an email address or other means of
communication.
|