Shoulder Replacement Surgery

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Shoulder replacement

Shoulder replacement is a surgical procedure in which all or part of the glen humeral joint is replaced by a prosthetic implant. Such joint replacement surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage.
Shoulder replacement surgery was first performed in the United States in the 1950s to treat severe shoulder fractures. Over the years, shoulder joint replacement has come to be used for many other painful conditions of the shoulder, such as different forms of arthritis.
If nonsurgical treatments like medications and activity changes are no longer helpful for relieving pain, you may want to consider shoulder joint replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain and help you resume everyday activities.
Whether you have just begun exploring treatment options or have already decided to have shoulder joint replacement surgery, this article will help you understand more about this valuable procedure.

Types of Shoulder Surgery:
Shoulder surgery can be used for a number of treatments:
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... • Arthroscopic acromioplasty - This is an arthroscopic procedure to widen the space between the upper arm and the shoulder blade so that the rotator cuff tendons do not get stuck between them.

Arthroscopy with shoulder instability - In case of dislocation of the shoulder, it is normal to have an arthroscopy. It is often possible to repair damage to the shoulder but sometimes a separate operation is needed.
• Rotator Cuff Repair - Arthroscopic repair of the shoulder tendons. The goal of these procedures is to minimize the pain, restore strength and functionality.
• Total Shoulder Replacement - Shoulder arthroplasty - With loss of cartilage the patient will suffer severe shoulder arthritis. This is quite painful, and can cause restriction of motion eventually surgical treatment is necessary.

Shoulder Arthroscopy
After an anesthetic has been administered, your surgeon and the operating room staff will then make sure that you are correctly position on the operating table. For some shoulder surgeries you will be placed in the "beach chair" position, as if you are reclining on a beach chair.

Other types of shoulder surgery require that you lie on your side and have your arm in traction. This position is becoming more popular and is now quite common for arthroscopic rotator cuff repairs.
Shoulder arthroscopy is performed through "portals". These are small incisions, generally about 10cm long are located over particular areas of the joint that the orthopedic surgeon will need to operate upon. Small plastic tubes, called "cannulas" are then inserted into the portals so that instruments can easily be placed in the shoulder joint. Shoulder arthroscopy itself involves inserting a specially designed video camera with a very bright fiber optic light source into the shoulder joint so that the important parts of the joint can be seen. Instruments that have been specially designed to remove inflamed tissue, attach sutures to bone, and repair tears and damaged tendons are then used to operate inside the shoulder.
Once the procedure is finished, the instruments, camera, and cannulas are removed, the wounds are closed with either suture or staples, and a sterile dressing is applied to the shoulder. The shoulder is then placed in a sling or immobilizer, the patient is moved from the operating table to a hospital bed, and then wheeled back to the recovery room.
Diagnosis of Rotator Cuff

As well as a physical diagnosis the following diagnostic tools can be used:
• X-rays of the shoulder will be obtained if there is a concern of a rotator cuff tear. The surgeon will look for signs of a rotator cuff tear, although the rotator cuff tear itself cannot be seen on a regular x-ray. Signs of a problem within the rotator cuff include a narrowing of the space for the rotator cuff and bone spurs around the rotator cuff tendons.
• MRI - is helpful because it can show both complete rotator cuff tears and partial rotator cuff tears. The MRI can also show evidence of shoulder bursitis and other common shoulder problems.
• Arthrogram - once was the most commonly used test to diagnose a rotator cuff tear. In this study a dye (contrast dye) that shows up on x-ray is injected into the shoulder joint. An intact rotator cuff should contain the dye within the joint, while a rotator cuff tear will allow the dye to leak into surrounding tissues. By taking an x-ray after an injection, your doctor can see evidence of a rotator cuff tear.
• Ultrasound - operated by a skilled technician, can be as effective detecting a rotator cuff tear as these other methods. Depending on your doctor's preference, you may undergo an ultrasound study to diagnose a rotator cuff tear.
Rotator Cuff Treatment:
The first steps of rotator cuff treatment include:
• Physiotherapy - is the most important step in the treatment of a rotator cuff injury. Strengthening the rotator cuff muscles is important to maintain normal shoulder function. A physiotherapist can show you exercises to help alleviate and prevent a recurrence of your shoulder pain.
• Anti-Inflammatory Medications - anti-inflammatory medications can be taken regularly for a short period, and can be used to alleviate pain and when symptoms of a rotator cuff tear flare up.
• Cortisone Injections - Cortisone injections promote rapid healing and can limit the acute inflammatory process, allowing the patient to begin therapy. It is important to participate in the therapy and exercises even if the shoulder feels better after an injection. Physiotherapy will help prevent a recurrence of symptoms. This may help to relieve pain and strengthen the muscles around the joint.
Work:
A rotator cuff is a hard worker. It's made up of the muscle and tendons in your shoulder and connects your upper arm bone with your shoulder blade.
Accord to the Mayo Clinic, the anatomy of a rotator cuff results in the largest range of motion attributed to any of your joints.
While rotator cuff injuries are linked to a number of events, they all have one thing in common: they can be very painful. Many of these injuries - which can occur from normal wear and tear due to age as well as from specific events - eventually heal from self-care or from physical therapy. However, for many years, patients dreaded this type of injury because surgery to repair the joint was such a common and uncomfortable solution.

Total Shoulder Replacement:

Total shoulder replacement surgery replaces damaged bone and cartilage with a metal and plastic implant. The shoulder joint is a ball-and-socket joint, much like the hip joint. The ball is the top of the arm bone (the humerus), and the socket is within the shoulder blade (scapula). This joint allows people an enormous range of motion at the shoulder.
When shoulder replacement surgery is performed, the ball is removed from the top of the humerus and replaced with a metal implant. This is shaped like a half-moon and attached to a stem inserted down the center of the arm bone. The socket portion of the joint is shaved clean and replaced with a plastic socket that is cemented into the scapula.

After Total Shoulder Replacement Surgery:

You will need to wear an arm sling for a few days. You should not attempt to use the arm except as specifically instructed by your doctor. Most physicians will begin some light physiotherapy immediately following surgery, but this may not be true in every case. Usually within two to three months, patients are able to return to most normal activities and place an emphasis on strengthening the muscles around the shoulder and maintaining range of motion.

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