Shoulder Replacement
Total shoulder replacement surgeries (TSA) have been performed in the United States since the 1950s. The surgery is now more common, similar to total hip & knee replacement surgeries. It has become a viable method for reducing shoulder pain & improving people’s ability to tolerate their normal activities. The most common reasons for having the surgery are joint osteoarthritis (OA), rotator cuff tears, avascular necrosis, & rheumatoid arthritis (RA).
The shoulder joint is a ball & socket joint, similar to the hip joint. Though the shoulder can move through much greater ranges of motion compared to other joints in the body. The bones of the shoulder include the scapula (shoulder blade), the clavicle (collar bone), & the humerus (arm bone). The clavicle attaches to the scapula at the acromioclavicular joint (AC joint). The clavicle then attaches your shoulder to the sternum at the sternoclavicular joint (SC joint). The ball of the humerus (upper arm bone) rests against the glenoid (the socket in the shoulder blade) to make the glenohumeral joint. Shoulder replacement surgeries involve replacement of the humeral head & glenoid surfaces. The rotator cuff is a group of four muscles which originate on the scapula & attach via tendons on the upper humerus. The functions of the rotator cuff are to provide stability to the glenohumeral joint & to help move the shoulder joint. Tears of the rotator cuff may therefore cause joint instability, pain, & decrease in functional use of the arm. Rotator cuff tears may be addressed with physical therapy to improve a patient's range of motion, pain, & functional use of their arm. Depending on a patient’s age, pain, size of the tear, & desired level of activity, surgery may be appropriate.
Types of Shoulder Replacements
Anatomic Total Shoulder Replacement - both the ball & the socket are replaced. This procedure is typically done with shoulder joint osteoarthritis (wear & tear type arthritis).
Reverse Total Shoulder Replacement - both the ball & the socket are replaced, but they are reversed. This procedure is typically done with a combination of shoulder joint arthritis & significant damage to the rotator cuff.
Partial Shoulder Replacement (hemi arthroplasty) - only the humeral head (ball) is replaced with a ball & stem.
Resurfacing Hemiarthroplasty - replacement of the humeral head joint surface only without a stem.
Rehabilitation/Recovery
A shoulder sling will be worn for 2-6 weeks following the surgery. Physical therapy commonly starts immediately following the surgery, but may depend on the individual surgeon’s instructions. PT will initially emphasize limited passive range of motion & patient education regarding precautions. Gentle strengthening exercises may be initiated approximately 4-6 weeks following the surgery, depending on the complexity of the surgery & the surgeon’s individual instructions.
Precautions
Common precautions following the surgery include keeping a pillow under elbow when lying on your back, avoiding lifting, avoiding forceful inward movement of the arm, weight bearing throughout the involved arm, & initially avoiding raising the arm away from the body.
Prognosis
Studies have found that the majority of patients who have the total shoulder replacement obtain shoulder pain relief following. Often patients will be able to gain functional reaching ability following the surgery, such as reaching to the top of one’s head. A patient’s ability to reach overhead or out from their side following the surgery may depend on whether the rotator was completely torn, such as those requiring the reverse total shoulder surgery.
The shoulder joint is a ball & socket joint, similar to the hip joint. Though the shoulder can move through much greater ranges of motion compared to other joints in the body. The bones of the shoulder include the scapula (shoulder blade), the clavicle (collar bone), & the humerus (arm bone). The clavicle attaches to the scapula at the acromioclavicular joint (AC joint). The clavicle then attaches your shoulder to the sternum at the sternoclavicular joint (SC joint). The ball of the humerus (upper arm bone) rests against the glenoid (the socket in the shoulder blade) to make the glenohumeral joint. Shoulder replacement surgeries involve replacement of the humeral head & glenoid surfaces. The rotator cuff is a group of four muscles which originate on the scapula & attach via tendons on the upper humerus. The functions of the rotator cuff are to provide stability to the glenohumeral joint & to help move the shoulder joint. Tears of the rotator cuff may therefore cause joint instability, pain, & decrease in functional use of the arm. Rotator cuff tears may be addressed with physical therapy to improve a patient's range of motion, pain, & functional use of their arm. Depending on a patient’s age, pain, size of the tear, & desired level of activity, surgery may be appropriate.
Types of Shoulder Replacements
Anatomic Total Shoulder Replacement - both the ball & the socket are replaced. This procedure is typically done with shoulder joint osteoarthritis (wear & tear type arthritis).
Reverse Total Shoulder Replacement - both the ball & the socket are replaced, but they are reversed. This procedure is typically done with a combination of shoulder joint arthritis & significant damage to the rotator cuff.
Partial Shoulder Replacement (hemi arthroplasty) - only the humeral head (ball) is replaced with a ball & stem.
Resurfacing Hemiarthroplasty - replacement of the humeral head joint surface only without a stem.
Rehabilitation/Recovery
A shoulder sling will be worn for 2-6 weeks following the surgery. Physical therapy commonly starts immediately following the surgery, but may depend on the individual surgeon’s instructions. PT will initially emphasize limited passive range of motion & patient education regarding precautions. Gentle strengthening exercises may be initiated approximately 4-6 weeks following the surgery, depending on the complexity of the surgery & the surgeon’s individual instructions.
Precautions
Common precautions following the surgery include keeping a pillow under elbow when lying on your back, avoiding lifting, avoiding forceful inward movement of the arm, weight bearing throughout the involved arm, & initially avoiding raising the arm away from the body.
Prognosis
Studies have found that the majority of patients who have the total shoulder replacement obtain shoulder pain relief following. Often patients will be able to gain functional reaching ability following the surgery, such as reaching to the top of one’s head. A patient’s ability to reach overhead or out from their side following the surgery may depend on whether the rotator was completely torn, such as those requiring the reverse total shoulder surgery.