Total shoulder replacement, also known as total shoulder arthroplasty, is the removal of portions of the shoulder joint, which are replaced with artificial implants to reduce pain and restore range of rotation and mobility. It is very successful for treating the severe pain and stiffness caused by end-stage arthritis.
Shoulder arthritis is a condition in which the smooth cartilage that covers of the bones of the shoulder degenerate or disintegrate. In a healthy shoulder, these cartilage surfaces permit the bones to comfortably glide against one another. When these cartilage surfaces disappear, the bones come into direct contact, increasing friction and causing them to roughen and damage each other. Bone-on bone movement can be quite painful and difficult. Surgically implanted artificial replacement surfaces restore pain-free movement, strength and function.
What causes the conditions treated by shoulder replacement surgery?
There are two basic types of arthritis that affect the shoulder.
Osteoarthritis (OA): This is physical wear and tear on the cartilage inside the joint that develops from years of use. Although many older adults experience OA at some point, they are more likely to get it in their knees, hips or fingers than the shoulder. Osteoarthritis in the shoulder is more common in exceptionally active people (even at younger ages), such as tennis players, weightlifters and other athletes who put continual pressure on their shoulders. In some cases, a severe, acute injury triggers or contributes to this long-term damage, for example:
torn rotator cuff
Inflammatory arthritis (IA): This is an umbrella term for several chronic, autoimmune diseases which have no completely understood cause. The main two that affect the shoulder are:
Many people with these conditions who have replacement surgeries experience reduced pain and improved function in the shoulder. (Some ankylosing spondylitis patients may also benefit from elbow replacement.)
How do I know if I need a shoulder replacement?
The most common reason for a person to have this surgery is when they have shoulder arthritis pain that can’t be controlled with nonsurgical treatments. The pain is usually accompanied by a progressive stiffness and a grinding or grating sensation in the shoulder.
These symptoms indicate that bones that form the ball and socket of the shoulder joint are rubbing against one another because the cartilage that should lie between them has worn away.
Diagnosing conditions that may be treated with a shoulder replacement
To diagnose arthritis in the shoulder, a doctor will order a series of standard X-rays. A CT scan may also be necessary to evaluate a patient’s bone integrity, and magnetic resonance imaging (MRI) may be ordered to determine the condition of important surrounding soft tissues, such as the rotator cuff tendon.
If the doctor suspects there may be nerve damage, based discussions with the patient, an EMG test or nerve conduction study may be ordered to evaluate the nerves that feed the important muscles of the shoulder.