October 5, 2015
Why an Article on Shoulder Treatment Education?
Proper shoulder treatment education is important when you or someone you love has a shoulder injury. The shoulder is a very delicate joint. Simple tasks like picking up pans, opening a window, moving a chair, or carrying a child can cause shoulder injuries. Activities like tennis, football, volleyball, and martial arts can cause further shoulder damage. Unfortunately, simply aging can cause tendon pain in the shoulder. Below are some of the common treatment options. Shoulder treatment education would not be complete without mentioning some of our non-surgical options, but we will get into those in a later post.
What is Shoulder Arthritis?
Arthritis is a common disease that affects the shoulder, causing joint pain, stiffness and swelling. When a person gets arthritis, they lose cartilage or the cushion in the joint. Cartilage allows the joint to glide easily during motion. When cartilage wears, there is bone on bone rubbing which can be painful. In addition, the joint becomes inflamed and there is usually a restriction of motion.
How is Shoulder Arthritis diagnosed?
Many patients will complain of a deep ache that can radiate to the lateral arm. The pain usually gets worse with movement or activity. With time, there may even be pain at rest and eventually, patients will awaken at night with shoulder pain. Patients will complain of grinding and difficulty with motion. In the office, a physician will diagnose arthritis through a thorough physical exam and taking the proper x-rays.
What is Shoulder Replacement Surgery?
In total shoulder replacement, the damaged surfaces of the humeral head and glenoid socket are resurfaced with metal and plastic implants. The humeral head is replaced with a metal component and the glenoid socket is replaced with a polyethylene component that is glued in with bone cement. When both sides of the shoulder are replaced, it is called a total shoulder replacement. When only the humeral head is replaced, it is called a shoulder hemiarthroplasty or a partial shoulder replacement.
Why should I consider Shoulder Replacement Surgery?
Shoulder replacement surgery should be performed to alleviate pain and improve function. It is an excellent option for patients that have failed other conservative measures such as physical therapy and antiinflammatory medication.
How long will my Shoulder Replacement last?
Anytime implants are used to replace your normal anatomy, it is expected that they will wear with time. The survivorship of a shoulder replacement is up to 93% at 10 years and 87% at 15 years. (Torcia et al.) At one year from the time of surgery, 98.5% patients are glad they had the procedure done. Ninety percent of patients feel that their new shoulder has attained the 80 percent of what they feel a “normal” shoulder would be and 37 percent of patients think that their new shoulder is normal. (Warner et al.)
What are my restrictions after a Total Shoulder Replacement?
Most activities can be resumed after a shoulder replacement. A person usually resumes activities such as swimming, golf and tennis by six months after surgery. Activities that involve major impact (such as contact sports or those where falls are frequent) or heavy loads (such as lifting heavy weights) should be avoided since these may increase the chance of rotator cuff tears, hardware loosening, increased wear and/or fracture.
What will be my recovery time?
Patients whom undergo total shoulder replacement usually stay in the hospital for 1-3 days after surgery. Physical therapists will begin moving the shoulder on the first postoperative day and patients will wear a sling for the first 4-6 weeks. At that time, patients can use their shoulder as tolerated with a weight restriction of 5 pounds. Most activities can resume in 4-6 months.
What are the risks of Shoulder Surgery?
Complications are rare, but they are also real and do happen. Some of the more common complications include infection, stiffness, instability, component failure, fractures around the prosthesis and failure to get complete pain relief. Fortunately, the benefits of shoulder replacement far outweigh the risks.
What is the difference between a chronic torn rotator cuff and acute tear?
Do both require surgery?
An acute rotator cuff tear is a tear that occurs after an injury. There is usually sudden pain in the shoulder accompanied by limited movement and weakness. A chronic tear is a tear that is greater than 6 to 12 weeks old. They usually involve the dominant arm and gradually worsen. People may develop weakness. There are many functioning patients with chronic tears. At sixty, fifty percent of asymptomatic patients would have a partial thickness rotator cuff tear if they had an MRI. At 80, fifty percent of patients would have a full thickness tear (all the way through). Chronic tears usually require surgery if the patient has persistent pain or weakness despite 6-12 weeks of physical therapy. Most acute rotator cuff tears or tears in young patients should be fixed surgically.
Why do physicians recommend a total shoulder replacement now?
Ten years ago, I never heard of a total shoulder. Shoulder arthritis is a common disease affecting thousands Americans annually. Many people with shoulder arthritis will have adequate pain control and function using anti-inflammatory medication and physical therapy. For patients that fail to improve with non-operative management, shoulder replacement is an excellent alternative. Up to 40,000 shoulder replacements are performed annually. At one year from surgery, 98.5% patients state that they are glad they had their shoulder replaced and would do it again. The successful results of shoulder replacement are similar to those for hip replacement surgery.
Do you have to repair a torn bicep even if it was injured five months ago?
The biceps is a muscle on the front of the shoulder that allows a person to flex and supinate the elbow. It has two muscle bellies, the long head of the biceps that inserts on the labrum at the top of the shoulder socket and the short head of the biceps that inserts on the front of the scapula at its coracoid. At the elbow, the bicep muscle bellies merge into one tendon that inserts into the radius. When a patient ruptures the distal part of the biceps, they may lose up to 40% of their strength with flexion and supination. Surgery is typically recommended when it is the dominant arm and the patient’s job requires significant use of the arm. Surgery is not always recommended for ruptures that occur near the shoulder at the long head of the biceps. Most people respond well to physical therapy.
I am a senior and I don’t want surgery but I can’t lift my arm, would therapy help relieve the pain?
There are many reasons a person may have pain in the shoulder and not all of them need to be treated surgically. Most shoulder ailments improve with physical therapy. It is helpful to have a thorough physical exam so that physical therapy can be guided appropriately. Sometimes, a platelet injections (platelet injections) or steroid injection can be helpful.
We hope this shoulder treatment education article has been helpful! For any additional questions or treatment options, give us a call at (513) 354-3700 or schedule an appointment with Dr. Robert Rolf!