How has this happened and why?
Damage to and degeneration of the normally smooth cartilage of the shoulder joint causes arthritis. This process is irreversible and progresses over many years, often without causing symptoms in the early stages.
Sometimes there are specific episodes of trauma that cause the arthritis, more commonly it is repeated episodes of micro-trauma, sometimes work related, or other conditions such as rheumatoid arthritis. The main symptoms of shoulder arthritis are pain, stiffness and loss of function (stiffness). Changes can be rapid once they reach a tipping point.
Partial thickness tears can be treated with anti-inflammatory medications and physiotherapy to strengthen the intact tendons and rebalance the shoulder. Even with full-thickness tears non-operative treatment can result in a full range of motion and acceptable strength. There is a risk of cuff tears progressing and enlarging with time and resulting in the need for surgical repair.
In an ideal world the tendon quality and tear pattern allows solid re-attachment (repair) and full recovery after surgery and an appropriate rehabilitation period.
Age of patient, age of tear, medical comorbidities especially diabetes and smoking, and other factors can degrade the quality of the tendon which can become so poor that a surgical repair is not possible. Torn tendons of this type mean that the attached muscle shrinks and atrophies into fat rendering it non-functional. Sometimes a partial repair is possible in these cases, sometimes not.
Most cuff surgery is performed via a keyhole approach to allow better visualisation of the tear, faster early recovery, and a lower infection rate surgery. Long-term results are equivocal with an open technique.
Surgery is performed under a general anaesthetic with a nerve-block to reduce post-operative pain which makes the affected arm numb for 18-24 hours. Patients usually are in hospital overnight and return home the day after surgery following a review by the relevant Physiotherapist. A shoulder sling is used for six weeks and an appropriate physiotherapy program is started from day 1 post-operatively.
What is shoulder replacement like?
Surgery is performed under a general anaesthesia, almost always with a local anaesthetic block to make the entire arm numb for 18-24hours. The incision is over the anterior (front) aspect of the shoulder and is 12-15cm long. Patients usually stay in hospital for two or three nights. A sling should be worn for 2 or 6 weeks depending on the type of replacement undertaken. A specific physiotherapy program is started the morning after surgery with the aims being early active range of motion within safe parameters, preventing stiffness as much as possible but safe-guarding against complications like dislocation and unnecessary pain. While most patients will be very satisfied by 2-3 months following their procedure, improvements will continue in the first 12 months at a minimum and final outcome can take some time to achieve.
Advances in surgical techniques and marked improvements in prosthetic materials have allowed the majority of shoulder joint replacements to last fifteen years or more.
This page is a brief overview and not designed to be all-inclusive. If you have any further queries, please contact us.