Shoulder Replacement

Shoulder Replacement

Understanding the Shoulder joint.

It helps to understand how the shoulder joint is structured before exploring the shoulder replacement. The shoulder joint mainly consists of three main bones:

1) Humerus (upper arm bone)

2) Scapula (shoulder blade)

3) Clavicle (collarbone).

Functioning as a ball-and-socket joint, the round head of the humerus articulates into a shallow cavity on the scapula called the glenoid.

The bone surfaces are covered with a smooth layer called cartilage, a slippery tissue that enables smooth, friction and pain free motion. A thin lining, the synovial membrane, covers the inner surfaces and secretes lubricating fluid to ensure smooth joint movement. Muscles and tendons around the joint provide stability and strength, allowing the shoulder to move freely in multiple directions.

Shoulder pain:-

It is one of the most common musculoskeletal complaints seen in the patients, and it may range from mild discomfort to severe restriction of movements that can interfere with daily life activities.

Signs and symptoms:-

• Dull or sharp pain in the upper arm, which can radiate to the forearm, neck, or back.
• Difficulty in lifting the arm for overhead activities.
• Stiffness, weakness, or restriction of movements
• Discomfort even while resting, which can interrupt sleep
• Swelling or tenderness in the joint
• These symptoms tend to worsen over time and can significantly affect daily activities and overall quality of life

Common causes for shoulder pain:-

• Osteoarthritis (Degenerative Joint Disease): The most common cause, typically affecting individuals over 50 years of age.
• Rheumatoid Arthritis: Chronic inflammation of the synovial membrane can destroy cartilage.
• Rotator cuff injuries: Tears, tendinitis or impingement can alter joint mechanics and eventually result in arthritis and functional impairment
• Trauma: causing a fracture or dislocation may damage the cartilage over time, leading to arthritis.
• Frozen shoulder/adhesive capsulitis: Thickening of the joint capsule, limiting movement
• Bursitis: Inflammation of the bursa in the joint
• Nerve-related: Cervical spine compression/disc.

Treatment modalities:-

1. Conservative Management:

Rest and activity changes to reduce strain

Ice or heat therapy for pain and swelling of the joint

Anti-inflammatory drugs and pain control medications

Steroid injections to the joint for inflammation control

2. Physiotherapy and Rehabilitation:

Gentle stretching and strengthening exercises improve movements in some people

Posture correction

Hydrotherapy

Focused exercises to restore shoulder flexibility and increase mobility.

3. Surgical procedures:-

• Arthroscopic Surgery:- Minimally invasive, used for rotator cuff repair, bone spur removal, or frozen shoulder release.
• Repair of ligaments or labrum after recurrent dislocations.
• Shoulder Replacement Surgery (Arthroplasty) types:-
• Total Shoulder Replacement: In this procedure, both parts of the joint are resurfaced, the humeral head is replaced with a metal ball fixed to a stem, and the glenoid is fitted with a high-grade plastic socket.
• Stemmed Hemiarthroplasty: Only the humeral head (ball) is replaced, leaving the socket intact. This is commonly recommended for fractures of the humeral head where the glenoid remains healthy.
• Resurfacing Hemiarthroplasty: Instead of replacing the entire ball, only its surface is fitted with a prosthetic cap. This bone-preserving option is suitable for some patients with mild to moderate arthritis.
• Reverse Total Shoulder Replacement: In this advanced procedure, the ball and socket positions are reversed, the ball is fixed to the shoulder blade, and the socket to the humerus. This approach allows patients with severe rotator cuff damage to use the deltoid muscle for arm movement

When and Why Shoulder Replacement Is Needed ?

Shoulder replacement surgery is considered when pain and functional limitations cannot be managed with medications, physical therapy, or other conservative measures and patients have persistent pain (even at rest or while sleeping), Stiffness and reduced mobility, Weakness or difficulty with daily activities.

This surgery is usually recommended in cases such as:

• Osteoarthritis (Degenerative Joint Disease)
• Rheumatoid Arthritis
• Post-Traumatic Arthritis
• Rotator Cuff Arthropathy

Preparing for Surgery

Prior to surgery, patients undergo a thorough evaluation, including physical examinations and necessary medical tests, to confirm they are fit for the procedure. Doctors review all medications, adjusting or pausing them if necessary. Patients are advised to arrange help for everyday activities such as dressing, bathing, and cooking during the early recovery period, as shoulder mobility will be limited.

How the Surgery Is Performed

On the day of the operation, patients are assessed by the anesthesiologist, who determines the type of anesthesia, either general (full-body) or regional (targeted to the shoulder).

The surgical procedure typically lasts around 2 hours. The damaged sections of the joint are carefully removed and replaced with prosthetic implants. Depending on the type of surgery, this may involve replacing only the humeral head or both the humeral head and glenoid socket.

Recovery and Rehabilitation

After the procedure, antibiotics are administered to prevent infection. Patients are encouraged to begin light movement within a day or two and are usually discharged within 48 hours. Some post-operative pain is expected, but it is managed effectively with medications.

Physiotherapy begins shortly after surgery, once pain levels are manageable. A sling is typically used for two to four weeks to support the healing joint. Patients are advised not to soak the surgical wound until it has fully healed and to strictly follow the prescribed home exercise program to ensure optimal recovery.

Outcomes of Shoulder Replacement

Patients experience substantial improvement in pain levels and joint function following shoulder replacement surgery and consistent rehabilitation. Patients can expect:

• Restoration of near-normal shoulder mobility
• Improved ability to perform daily tasks
• Significant reduction or elimination of pain
• Long-term durability, often lasting 15 years or more, depending on activity levels and implant quality

When performed at specialized orthopedic hospitals, shoulder replacement surgery has a high success rate and provides patients with improved quality of life and independence.