Reading
Berkshire
Harley Street
London
Shoulder Osteoarthritis
What?
Arthritis is a disease that affects your joints . Arthritis usually involves inflammation or degeneration (breakdown) of the cartilage (Smooth surface) that forms your joints. These changes can cause pain when you use the joint.
Why?
Who?
Like any other joint in the body the shoulder joint can wear over time 'arthritis' causing pain and stiffness.
This is known and 'Osteoarthritis' and is the most commonest reason for joint pain and stiffness. In some cases osteoarthritis develops rapidly after a fracture.
The other cause of arthritis is due 'autoimmune' diseases such as Rheumatoid arthritis.
In relation to the shoulder there are two main causes of shoulder arthritis and both are treated differently.
The most common cause of age related shoulder arthritic is due to long standing failure of the rotator cuff. The rotator cuff are the tendons that wrap around the shoulder joint and function together to allow the shoulder to move normally.
The Supraspinatus tendon (One of the four rotator cuff muscles/ tendons) is the most commonest tendon subject to wear and tear, and once this fails your humeral head ' Ball of the shoulder joint' migrates upwards causing wear of your joint cartilage and difficulty raising your arm. This type of arthritis is known as 'Cuff Arthropathy'.
The second type of athritis is where the rotator cuff tendons are working normally but the shoulder joint surface 'cartilage' has worn out causing pain and stiffness. This is known as 'Gleno-humeral Osteo-arthritis'.
Osteoarthritis 'natural wear and tear of your joints' becomes more common with advancing age. Cuff arthropathy which develop arthritis after failure of your rotator cuff tendons which happens with aging, is more common in people over 70 year of age.
Gleno-humeral osteoarthritis where the rotator cuff tendons are working normally is more common in people under 65 years of age.
DIAGNOSIS:
The main symptoms of arthritis of the shoulder joint are pain and stiffness. Generally a plain x ray will demonstrate of you have lost the normal shoulder joint space indicating arthritis.
TREATMENT:
The treatment of arthritis of the shoulder depends on the severity of your symptoms. Generally, the first line of management is aimed at controlling your symptoms with painkillers a steroid injection into the joint or a nerve block. If your shoulder pain and stiffness is affecting your quality of life, restricting your ability to care for yourself and affecting your sleep than you should consider a shoulder replacement. The primary goal is to improve your pain and function.
A shoulder replacement put simply resurfaces the worn out joint surface with an artificial joint made of metal ball and a plastic socket.
In general the type of shoulder replacement indicated depends on age, condition of the rotator cuff tendons and severity of bone loss. There are three main types of shoulder replacements:
1) Hemiarthroplasty (Replacement of the humeral head 'ball') 2) Anatomical Shoulder Replacement (Replacement of both the ball and glenoid 'socket') 3) Reverse shoulder replacement.
-
If you have been advised to undergo a Reverse shoulder replacement please see below.
-
If you have been advised to undergo an Anatomical shoulder replacement please click on the link.
REVERSE SHOULDER REPLACEMENT (RSR)
A Reverse shoulder replacement as its description suggests reverses the 'ball and socket' of the shoulder. This type of shoulder replacement is indicated in Rotator cuff arthropathy, where your rotator is completely torn and non-functional. The design of this type of implant allows your shoulder to function without the rotator cuff muscles by using your Deltoid muscle to elevate your shoulder.
How?
'Vish uses the latest planning software to individually plan your shoulder recontruction to get you the best possible results.'
Me?
TREATMENT OPTIONS:
The decision to undergo a Reverse Shoulder is yours and my duty as your surgeon is to help guide you. My general guidance to patients is a joint replacement is considered once you have failed to improve with non- operative treatment measures which include at least one cortisone/ steroid injection, physiotherapy and pain killers.
The outcomes of a Reverse Shoulder replacement are good and generally 90% of patients improve by 6 months. In the longer term at least 90% of Reverse shoulder replacements are functional (Not needing re-do surgery) at 10 years.
A Joint replacement is major surgery and is performed whilst you under a general anaesthetic which will be performed a Consultant anesthetist. You will also be offered a intrascalene nerve block to help with pain. The majority of my patients stay one night in hospital after the procedure.
General anaesthesia is very safe but still carries a small risk (<1%) of Heart Attack, Stroke, Deep Vein Thrombosis, Pulmonary embolism (< 0.5%). It is important to have all details of your medications and past medical history so you can be optimised for surgery and these risks can be assessed individually.
It is important that you understand the risk of surgery which are outlines below:
-
Infection (<1%)
-
Nerve & Vessel damage (<1%)
-
Persistent pain / stiffness(5%-10%)
-
Dislocation (1-5%)
-
Revision 'Re-do' for loosening/ wear (5-10 % at 10 years)
-
Fracture (1-2%)
How long do I stay in hospital after the operation?
Generally most of my patients stay 1-2 days in hospital after surgery.
How long do I wear a polysling?
You will need to wear a polysling for 2 weeks to protect the repaired tissues. You able to remove it for axillary hygiene and changing clothes but your arm must be kept close to your chest as possible.
Can I get my dressings wet?
It is important to keep your wound dressings completely clean and dry to reduce the incidence of wound infection. It is normal to see some streaking of blood in the dressing but not frank blood or foul smelling discharge.
When do my sutures come out?
I generally use dissolvable stitches. The suture ends will need to trimmed by the practice nurse at your GP Practice in 2 weeks.
What do I look out for after my Surgery?
Your nerve block shoulder wear off by 36-48 hours and you should have full function of your hand. If you have persistent numbness or weakness of you need to make us aware of this.
By 2 weeks your wound should be dry and largely healed. If you have any persistent discharge of fluid or increasing redness around the wound you should alert us.
What should I avoid doing after the procedure?
Avoid pushing down through the arm for 6 weeks e.g. pushing yourself out of a chair, out of bed or leaning on a walking stick.
When should physiotherapy start?
Physiotherapy should commence at 2 weeks after your surgery.
How should I expect to progress after surgery?
This is variable and dependent on the amount of movement and the strength of your muscles particularly your Deltoid muscle prior to surgery.
Following discharge your pain will slowly decrease and you will become more confident with moving your arm. You will be able to use your arm in front of you for light activities after your sling is removed at 2 weeks and will gradually improve.
After six weeks your strength will start to improve gradually. It is important to continue your exercises, as improvement in strength and range of movement will continue up to 12 months post-surgery.
When can I resume work/ recreational activities?
Timings for returning to functional activities are approximate and will differ depending upon the individual. However, the earliest that these activities may commence are:
-
Driving: 6-8 weeks or when safe.
-
Lifting: 6-8 weeks gradually building up.
-
Swimming: 6-8 weeks.
-
Return to work: Light work (no lifting) 2- 6 weeks.
Medium work (light lifting below shoulder level) from 3-6 months
Heavy work (above shoulder height ) - This must be discontinued.
Help?
Mayo Clinic Reverse shoulder Replacement patient information video
Useful external patient info links:
Arthritis Research UK Shoulder Replacement patient information leaflet
Post- Operative Reverse Shoulder Replacement Physiotherapy guidelines (RBH)
ANATOMICAL TOTAL SHOULDER REPLACEMENT
An Anatomical Total Shoulder replacement replaces the worn out joint surfaces with artificial implants.
The humeral Head 'Ball' is replaced with a Metal implant and the Glenoid 'socket' with a Plastic implant. The size of the implants are selected to match your normal shoulder anatomy.
This type of shoulder replacement can only be performed of your Rotator cuff tendons are intact and functioning normally.
Me?
Help?
Useful external patient info links:
TREATMENT OPTIONS:
The decision to undergo a Total (Anatomical) Shoulder Replacement is yours and my duty as your surgeon is to help guide you. My general guidance to patients is a joint replacement is considered once you have failed to improve with non- operative treatment measures which include at least one cortisone/ steroid injection, physiotherapy and pain killers.
The outcomes of a Total Shoulder replacement are good and generally 90% of patients improve by 6 months. In the longer term at least 90% of Total shoulder replacements are functional (Not needing re-do surgery) at 10 years.
The main reason for a Total shoulder replacement to fail are failure of your rotator cuff tendons, loosening of the implant or infection.
A Joint replacement is major surgery and is performed whilst you under a general anaesthetic which will be performed a Consultant anesthetist. You will also be offered a intrascalene nerve block to help with pain. The majority of my patients stay one night in hospital after the procedure.
General anaesthesia is very safe but still carries a small risk (<1%) of Heart Attack, Stroke, Deep Vein Thrombosis, Pulmonary embolism (< 0.5%). It is important to have all details of your medications and past medical history so you can be optimised for surgery and these risks can be assessed individually.
It is important that you understand the risk of surgery which are outlined below:
-
Infection (<1%)
-
Nerve & Vessel damage (<1%)
-
Persistent pain / stiffness(5%-10%)
-
Dislocation (1-5%)
-
Revision 'Re-do' for loosening/ wear/ Rotator cuff failure (5-10 % at 10 years)
-
Fracture (1-2%)
How long do I stay in hospital after the operation?
Generally most of my patients stay 1-2 days in hospital after surgery.
How long do I wear a polysling?
You will need to wear a polysling for 4 weeks to protect the repaired Rotator cuff tendon which is cut to gain access.. You able to remove it for axillary hygiene and changing clothes but your arm must be kept close to your chest as possible (avoid external rotation).
Can I get my dressings wet?
It is important to keep your wound dressings completely clean and dry to reduce the incidence of wound infection. It is normal to see some streaking of blood in the dressing but not frank blood or foul smelling discharge.
When do my sutures come out?
I generally use dissolvable stitches. The suture ends will need to trimmed by the practice nurse at your GP Practice in 2 weeks.
What do I look out for after my Surgery?
Your nerve block shoulder wear off by 36-48 hours and you should have full function of your hand. If you have persistent numbness or weakness of you need to make us aware of this.
By 2 weeks your wound should be dry and largely healed. If you have any persistent discharge of fluid or increasing redness around the wound you should alert us.
What should I avoid doing after the procedure?
Avoid pushing down through the arm for 6 weeks e.g. pushing yourself out of a chair, out of bed or leaning on a walking stick.
When should physiotherapy start?
Physiotherapy should commence at 4 weeks after your surgery.
How should I expect to progress after surgery?
This is variable and dependent on the amount of movement and the strength of your muscles and stiffness prior to surgery.
Following discharge your pain will slowly decrease and you will become more confident with moving your arm. You will be able to use your arm in front of you for light activities after your sling is removed at 4 weeks and will gradually improve.
After six weeks your strength will start to improve gradually. It is important to continue your exercises, as improvement in strength and range of movement will continue up to 12 months post-surgery.
When can I resume work/ recreational activities?
Timings for returning to functional activities are approximate and will differ depending upon the individual. However, the earliest that these activities may commence are:
-
Driving: 6-8 weeks or when safe.
-
Lifting: 10-12 weeks gradually building up.
-
Swimming: 10-12 weeks.
-
Return to work: Light work (no lifting) 4- 6 weeks.
Medium work (light lifting below shoulder level) from 3-6 months
Heavy work (above shoulder height ) - This must be discussed with your surgeon.