- Shoulder Arthroscopy
- Total Shoulder Arthroplasty
- Reverse Total Shoulder Arthroplasty
- Anatomic Total Shoulder Arthroplasty
The loss of the smooth frictionless cartilage on the surfaces of the humeral head (the ball) and the glenoid (the socket) can cause pain, loss of motion, and progressive functional loss. Although not as common as arthritis of the hip or knee, shoulder degenerative joint disease (DJD) can be a source of significant pain and loss of function.
There are many causes of shoulder DJD:
Osteoarthritis: The “wear and tear” arthritis that occurs when the articular cartilage of the joint is no longer protecting the bones. This can cause the bones to migrate closer causing pain
Post-traumatic arthritis: Occurs when there is an injury that causes a shift is the environment of the shoulder. The initial injury, such as a fracture, could have resolved and healed, but it caused damage to allow arthritis to initiate.
Rheumatoid arthritis: An autoimmune disease that affects many joints causing severe pain and aggressive arthritis.
Rotator Cuff Tear Arthropathy: DJD due to a long stating rotator cuff tear that is no longer repairable.
Avascular necrosis of bone (AVN): A condition where blood is interrupted to humerus causing decay. This can be caused by an injury or predetermining factors.
Dr. Nicholson has been involved with designing shoulder replacement systems and has been involved extensively in researching outcomes of shoulder replacement techniques. His extensive knowledge and experience allows him to individualize treatment for each patient based on their condition, severity of joint damage, age, gender, activity level, expectations, and rotator cuff ability.
The severity of arthritis is split up into categories; mild, moderate and severe. Mild OA shows minimal changes on x-ray of the joint but can still cause intermittent pain, difficulty with range of motion and sleep disturbance. Moderate OA shows narrowing of the joint space, sometimes can cause clicking and grinding sounds and pain with motion. Severe OA often has grinding and crepitus throughout full range of motion, sleep disturbance and difficulty with activities of daily living.
It’s important to know the severity of arthritis to dictate conservative versus surgical intervention. Conservative treatment can begin with over the counter medications and physical therapy. Often steroid injections are attempted if pain persists after an attempt of oral medication. When all conservative treatment is no longer effective to alleviate pain, Dr. Nicholson often discusses what type of replacement would be best.
In cases of early arthritis of the shoulder that have failed conservative management (medications, steroid injections, or physical therapy), arthroscopy may be an option. An arthroscopy is an outpatient surgery that would be done to clean up some of the arthritis in the shoulder, restore balance to the shoulder, and improve pain and range of motion. It does not cure or get rid of arthritis, but it can significantly reduce the symptoms of arthritis in a minimally invasive fashion.
Total Shoulder Arthroplasty
When advanced arthritis (often referred to as “bone on bone”) is present, and conservative management is not providing adequate relief, then a total shoulder arthroplasty or replacement may be an option. This surgery replaces both the ball and socket of the joint with a frictionless metallic ball and plastic socket. The anatomic total shoulder procedure replaces the damaged joint surfaces with a metal and plastic joint. This provides frictionless pain free restoration of motion and function. This is most appropriate when the rotator cuff is intact and functioning well.
This procedure is done through an open incision and is more invasive then an arthroscopy. It usually involves a 1-2 night inpatient stay in the hospital, but in selected patients can be performed as an outpatient procedure. Patients can expect to be in a sling for 4 weeks following the procedure and should participate in a physical therapy program to regain motion, strength, and optimal function.
Reverse Total Shoulder Arthroplasty
This type of shoulder replacement is most commonly used for a special type of arthritis called rotator cuff arthropathy. This type of arthroplasty reverses the orientation of the ball and the socket and alters the mechanics of the shoulder so that function can be restored without the presence of a rotator cuff. Indications for a reverse total shoulder are expanding. They include fracture problems, revision of existing implants, inflammatory arthritis, and failed rotator cuff repairs that cannot be re-repaired. Patients can expect to be in a sling for 4 weeks following the procedure.
Anatomic Total Shoulder Arthroplasty
The anatomic total shoulder procedure replaces the damaged joint surfaces with a metal and plastic joint. This provides frictionless pain free restoration of motion and function. This is most appropriate when the rotator cuff is intact and functioning well.
In certain situations, a hemiarthroplasty may be recommended. This is where only half of the joint, ball, or humeral head is replaced or resurfaced.
Within each type of shoulder joint replacement surgery, different implants can be used depending on your pattern of cartilage wear, clinical exam, age, and activity demands. These decisions are multi-factorial and are made during your office visit and sometimes intra-operatively. The goal is to provide the best pain-relieving procedure and achieve the highest functional level possible.