Friday, November 19, 2021

How Painful Is Total Shoulder Replacement Surgery

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What To Expect After A Total Shoulder Replacement Surgery

After total shoulder replacement surgery, youll be sent home with your arm in a removable sling. Most patients notice right away that there is no more grinding in their shoulder joint and arthritis pain is gone, though pain from the surgery itself is still present at the outset. You will be sent home with pain medication to help you feel comfortable as you heal.

Youll be able to use your hand and wrist right away, and youll gradually begin to move the arm itself in non-weight bearing movements. The following milestones are averages. Your recovery schedule may vary from this list.

6 weeks Youll be able to move the entire arm for light activity.

8 weeks Youll enjoy movement of your arm without restriction, but will experience some weakness and lack of range of motion.

3 months Youll be back to about 1/2 your normal range of motion with slight weakness.

6 months You should be pain free and have achieved 2/3 of your normal range of motion.

12 months 95% of all shoulder replacement patients report being completely pain free at one year.

Recovering From Shoulder Replacement Surgery

After surgery, you will be moved into the recovery room where you will stay for approximately two hours. During this time, you will be monitored until you awaken from anesthesia, at which time you will be taken to your hospital room. Your operated arm will be numb from the regional anesthesia, which also can provide good pain relief for the next day. Another side effect of the anesthesia is that you will not be able to move the fingers or wrist on the operated arm.

Typically, you will stay in the hospital for two to three days, but this depends on each individual and how quickly he or she progresses. After surgery, you may feel some pain that will be managed with medication to make you feel as comfortable as possible. This will be given either by injection or pump and should be used as needed. To avoid lung congestion after surgery, you should breathe deeply and cough frequently to clear your lungs.

A Cryocyff, an icing device that will help control pain and swelling, will be placed on your shoulder in the recovery room. You will be able to bring this device home with you and should use it frequently to minimize any discomfort you experience. In some instances, the insurance company may not approve the use of a Cryocyff, in which case we will use ice packs instead.

A Heightened Sense Of Shoulder Pain Caused By Runaway Inflammation Your Shoulder Hurts Worse Than It Should Because Your Shoulder Is Trying To Get Your Attention

  • In this paper from the University of Cincinnati, doctors say:
  • There is significant evidence showing that certain cytokines/chemokines are involved in not only the initiation but also the persistence of pathologic pain by directly activating nociceptive sensory neurons. , but also certain inflammatory cytokines are also involved in nerve-injury/inflammation-induced central sensitization and are related to the development of contralateral hyperalgesia/allodynia. .

What all this means is that your shoulder hurts worse than it should because your shoulder is trying to get your attention. What is your shoulder trying to get you to do? It wants you to stop doing what you are doing to make it hurt.

What Results Can I Expect From Reverse Total Shoulder Replacement

The reverse prosthesis is very good at providing pain relief. Studies from Europe indicate that approximately 85-90% of patients who have this procedure obtain excellent pain relief. The degree of pain relief depends largely upon the reason the procedure was done. The degree of pain relief for revision cases is a little lower than for procedures done for the first time, and this is believed to be due to the scar formation and long term damage.

The reverse prosthesis also should restore some range of motion to the shoulder, but the degree of return is not as predictable as pain relief. Most patients obtain the ability to reach the top of their heads without the need to tilt their head. Most patients see improvement of motion in other directions, but if their rotator cuff is torn completely they may not see improvement in the ability to reach out to the side away from the body .

The long term survival rates of the reverse prosthesis have been favorable. The reverse prosthesis has been used in France since the 1980s but was approved by the Food and Drug Administration in the United States in April, 2004. As a result, there are currently no long term studies of its use in the United States. However, the experience of shoulder surgeons and patients from Europe seem to indicate that the prosthesis will last 15 years about 90% of the time.

What Is A Shoulder Replacement Surgery

Shoulder Replacement Surgery  The Joint Replacement ...

The shoulder is a large ball and socket joint made up of bones, tendons, muscles and ligaments which hold the shoulder in place. Smooth cartilage protects the shoulder bones, allowing them to glide easily. During shoulder replacement surgery, the damaged parts of the shoulder are removed or resurfaced and replaced with artificial components . Your surgeon can discuss your treatment options and help you decide which is best for you.

Alternatives To Shoulder Replacement Surgery Prp And Prolotherapy

In this section, we will discuss the realistic treatment options to shoulder replacement surgery. We will focus on Prolotherapy and PRP injections.

  • PRP treatment takes your blood, like going for a blood test, and re-introduces the concentrated blood platelets from your blood into areas of chronic joint and spine deterioration.
  • Your blood platelets contain growth and healing factors. When concentrated through simple centrifuging, your blood plasma becomes rich in healing factors, thus the name Platelet RICH plasma.
  • The procedure and preparation of therapeutic doses of growth factors consist of an autologous blood collection , plasma separation , and application of the plasma rich in growth factors In our office, patients are generally seen every 4-6 weeks. Typically three to six visits are necessary per area.
  • Prolotherapy is an in-office injection treatment that research and medical studies have shown to be an effective, trustworthy, reliable alternative to surgical and non-effective conservative care treatments. In our opinion, based on extensive research and clinical results, Prolotherapy is superior to many other treatments in relieving the problems of chronic joint and spine pain and, most importantly, in getting people back to a happy and active lifestyle.

Contact Orthobethesda For Orthopedic Treatment For Your Shoulder Ailment Or Injury

If youre experiencing pain in your shoulder, its time to schedule an appointment at OrthoBethesda. Our doctors will determine the cause of your pain and develop a personalized treatment plan. At our patient-centric orthopedic care center, our entire staff has dedicated their skills to providing you with individualized care, from evaluation to diagnosis to treatment to recovery.

Surgical Considerations And General Principles Of Revision Surgery

Before the anesthetic, the patients consent is checked to make sure it is complete.  The instrument and implant inventory are verified for possible variations on the preoperative plan, including the need to modify a prosthesis or to possibly use a special implant .

The patient is anesthetized, positioned, prepped, and draped in a manner that anticipates all possible variations on the surgical plan.  The entire forequarter is prepped so that incisions can be made anteriorly, posteriorly, or distally as needed.  The arm is draped so that it can be moved freely.  Ipsilateral, iliac, crest, and hamstring autograft donor sites are prepped if their possible need is anticipated.

Preoperative antibiotics are not administered.  Prophylactic antibiotics are administered only after specimens are collected for culture and sensitivity testing.

The incision is made in a manner that provides optimal access to the mechanical problem and, if possible, incorporates or respects previous skin incisions.  The possible need for extending the incision is anticipated. As shown below, the coracoid is an important landmark when the normal anatomy of the deltopectoral interval is scarred from previous surgery through the anterior approach.

The humeroscapular motion interface is entered and all adhesions lysed. The axillary nerve is identified and protected.

So Here You Are Years Of Treatment Maybe A Past Surgery You Still Have Pain Why

Many times a patient will come into our office with advancing osteoarthritis of the shoulder. When they describe their shoulder pain they say things like:

  • My shoulder is barking at me today, or
  • My shoulder is letting me know it is there.

When we manipulate their shoulder to test for range of motion and we all hear the audible pops, clicking, and grinding, sometimes the patient tells us My shoulder is talking.

Intuitively these people know that their shoulder is talking to them. Do they understand what their shoulder is saying? Do you?

Revision Surgery Due To Superior Instability

Loss of the integrity of the coracoacromial arch can be a major problem following shoulder arthroplasty, allowing anterosuperior escape of the proximal humerus from the glenoid.  This problem is often caused by prior surgery attempting to repair a large rotator cuff tear. It is most commonly seen when an acromioplasty has been performed, compromising the stabilizing effect of the coracoacromial arch.

In this situation a reverse total shoulder arthroplasty may be considered.  

Weight Bearing Activities While Healing From Shoulder Surgery

You will likely have limits on the activities you can do with your shoulder . Some of these include:

do not pull objects toward your body do no roll your shoulder backward do not take your elbow behind the body avoid putting weight on the affected arm do not use the affected arm to push up from a sitting position do not use the affected arm to lift objects do not use the affected arm until your surgeon says its OK

It is very important that you fully understand your individual restrictions.  Take extra time to review these with your physical therapist and surgical team while in the hospital.

You may be allowed to shower 72 hours after surgery if you cover the surgical incision and dressing with plastic wrap. If youre not to take a shower, take a sponge bath until after the staples or sutures are removed and the incision can get wet. Dont bathe in tub or soak in a pool or hot tub where the incision is under water for at least 1 month. Again, review these instructions with your surgical team.

When Can I Return To Normal Activity After A Shoulder Replacement

A postoperative visit will likely be scheduled with your surgeon around two weeks after surgery. The purpose of this visit is to X-ray your implant to ensure everything remains in the correct position, as well as to ensure that no complications have arisen. The surgeon will examine the surgical wound and possibly remove sutures.

Depending on your surgery and the preferences of your surgeon, a very gradual return to motion will begin. Usually this begins with passive exercises, meaning gentle movement of the replaced joint, but without using the muscles in and around the replaced joint.

An example of this is taking hold of your right hand with your left hand, and using the strength in your left arm to raise your right arm while keeping the right arm limp.

Over the following weeks and months, this will progress to active motion, slowly re-building the strength of the muscles around your replaced joint. This may include simple waist-level activities around the house and using the arm for things like hygiene and dressing.

Finally, it is very important to keep in mind that although the arthritis is gone and you have a new freely-gliding joint surface, the overall healing process isnt fully complete until one year after the surgery! Most patients feel significant relief within weeks, but as with most things in life, patience is the key.

The Challenges Of Recovering From Shoulder Replacement

Total Shoulder Replacement Recovery Los Angeles

Stephanie Burke

Ron, the long-time moderator of the Forums on Spine-health, can often speak from experience when he interacts with users: He has had 7 spinal procedures, plus joint replacement surgeries for both hips and both shoulders.

When Ron speaks about his surgeries, hes quick to point out that the recovery process for shoulder replacement was by far the most challenging. Read about Rons experience with shoulder replacement surgery, which ultimately led to success after a lot of hard work and dedication.

Total shoulder replacement involves replacing the ball-and-socket parts of the joint with prosthetic components. Read more: Total Shoulder Replacement Surgical Procedure

In 2002, I started to notice some pain in my right arm. After a number of visits to an orthopedic surgeon, we went for a bone scan, which identified arthritis in both of my shoulder and hip joints. I was told that the onset of this osteoarthritis was brought on by my spinal surgeriesI have had 7 spinal surgeries, the first of which was in 1978.

Read more about Degenerative Arthritis

What Is Shoulder Replacement Surgery

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 .

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.

Are There Any Complications Of Shoulder Replacement Surgery

All surgeries come with some risk. There are several possible complications that follow shoulder replacement surgery:

  • Infection: Minor infections in the wound area are treated with antibiotics while major infections may require additional surgery.
  • Dislocation: In case of reverse total shoulder replacement, implant may dislocate which requires closed reduction or surgery to reduce or revise the implant.
  • Other prosthesis problems: Prostheses can wear down and sometimes the components can get loose. More surgery is sometimes needed.
  • Nerve injury: Nerves can be damaged during surgery.

There is an increased risk of complications if you have diabetes. Patients with diabetes may get wound complications and infections.

Surgical Options For Shoulder Replacement

Replacing or reshaping the damaged or diseased joint with a prosthetic one is called an arthroplasty. Depending on your age, overall health, and your specific shoulder joint problem, your may recommend one of the following procedures:

partial shoulder replacement reverse total shoulder replacement total shoulder replacement

Hemiarthroplasty replaces the head of the humerus with a prosthesis. The glenoid surface is left alone. Hemiarthroplasty can be done to repair a fracture of the humeral head or neck when the glenoid cavity isnt affected and is still functional. Besides fractures, other indications for hemiarthroplasty include:

osteoarthritis osteonecrosis of the humeral head Tumors of the humeral head Rotator cuff tears that cant be repaired, especially if accompanied by severe arthritis

Shoulder resurfacing replaces the surface of the humeral head with a metal covering, or cap. The glenoid surface may also be replaced using a plastic prosthesis. Shoulder resurfacing may be an option for younger, active patients with:

osteoarthritis osteonecrosis of the humeral head Rotator cuff tears that cant be repaired, especially if accompanied by arthritis

A major advantage of resurfacing is that it preserves bone for future shoulder procedures and surgeries. However, resurfacing is not recommended when severe bone loss is present or if the bone is not healthy enough to support the prosthesis.

Preparing For Your Surgery

Before you get your new shoulder, youâll likely get a full physical exam and X-rays or other imaging tests so the surgeon can get a look at the joint.

Talk to your doctor about any other conditions you have and any medications you take. Youâll have to stop taking certain drugs, especially painkillers, several weeks before surgery.

You may have to cut back on drinking and get more , too. If you smoke, youâll be asked to quit. Scientists have found folks who smoke are more likely to have complications from joint replacement surgery than those who don’t.

Donât eat or drink anything after midnight on the night before your operation.

The procedure takes about 3 hours. Doctors will give you drugs to put you under during the surgery.

Youâll want to be sure you have some help with your daily routine lined up for a few weeks after you come home from the hospital. You wonât be able to move your arm very much. If you donât have a relative or friend who can help you out, you might want to check into a rehabilitation center until you can do more things on your own.

The Anatomy Of The Shoulder

The shoulder is a complex joint capable of more movement than other joints in the body. Its made up of several bones.

  • Clavicle, or collarbone
  • Humerus, or upper arm bone
  • Scapula, or shoulder blade
  • Besides bones, other components are responsible for function and movement.

    • Ball and socket: Your upper arm bone head fits into your shoulder blade through a rounded socket known as your glenoid. Your articular cartilage, which is a slippery tissue, covers the surface of your ball and socket, creating a frictionless, smooth surface that helps your bones easily glide across one another. Strong fibrous cartilage rings your glenoid, which creates a gasket around your socket, adding stability and cushioning the joint.
    • Shoulder capsule: Bands of tissue called ligaments surround your joint, forming a capsule that holds it together. Your synovium, which is a thin membrane, lines the capsules undersurface. It makes synovial fluid that provides lubrication for your shoulder joint.
    • Rotator cuff: You have four tendons surrounding your shoulder capsule that help center your arm bone in your shoulder socket. This is your rotator cuff and is a thick tendon material. Your rotator cuff covers your humerus head, attaching it to your shoulder blade.
    • Bursa: Your bursa is a lubricating sac between the bone on top of the shoulder and your rotator cuff. Your bursa helps your rotator cuff tendons smoothly glide when youre moving your arm.

    When Is A Shoulder Replacement Recommended

    The shoulder joint can be replaced by an artificial shoulder or shoulder replacement for pain caused by arthritis or when the shoulder is severely fractured or broken. Arthritis is when the cartilage on the ends of the bones is gone and there is bone rubbing on bone in the joint. Arthritis can be caused by fractures, rheumatoid disease, torn rotator cuff tendons or just by wear and tear over time .

    Traditional Total Shoulder Replacement Surgery

    Traditional shoulder replacement surgery involves replacing the damaged parts of the ball-and-socket shoulder joint with prosthetic materials. Either the humeral head alone or both the humeral head and the glenoid socket are replaced with prostheses. The humeral head is replaced with a metal prosthesis, which is attached to a stem, while the glenoid socket is replaced with a medical-grade plastic prosthesis.

    Osteoarthritis and rheumatoid arthritis are the most common reasons for having traditional total shoulder replacement . However, if you have a completely torn rotator cuff, your orthopedic surgeon may recommend a reverse total shoulder replacement.

    Going For Shoulder Surgery

    Total Reverse Shoulder Joint Replacement

    Usually, on the day of the surgery, you will be admitted to the hospital or surgical unit early in the morning. The night before surgery, you must not eat or drink anything after midnight. Bring anything to the hospital your surgeon has asked you to bring including medications that you are currently taking as you may be in the hospital for a day or two. Take a shower and wash your hair before admissionit will be hard to wash your hair after surgery because you cant raise your arm. Try to get to bed early and get a good nights sleep.

    Dont Miss This Simple Breakdown Of Recovery Time For Total Shoulder Replacement Surgery

    Joseph A. Abboud, M.D.

    Here at Rothman Orthopaedic Institute, our shoulder and elbow specialists see patients for a wide variety of reasons and we offer non-surgical as well as operative approaches to care. Our ultimate goal, of course, is to reduce pain, increase mobility and restore patients to a healthy, active lifestyle.

    Total Shoulder Replacement Surgery

  • What does the recovery time for total shoulder replacement surgery look like?
  • Recovery Time for Total Shoulder Replacement Surgerypost-surgery experience

    • Youll be given antibiotics to prevent infection.
    • As soon as the day following surgery, youll be able to eat solid food.
    • Your surgeon will determine when you are ready to go home, but it will most likely be a day or two after surgery.

    First Days at Home:

    • Dont underestimate the importance of pain management.
    • Your surgeon and/or a physical therapist will teach you gently exercises to begin right away. You should commit to doing these regularly as they will contribute greatly to your ability to regain strength and range of motion.
    • Expect to have trouble reaching higher shelves and even completing daily tasks such as getting dressed, doing laundry and getting showered. Arrange to have help around the house for at least the first week.

    Weeks Two Through Four, Post Surgery:Up to Six Weeks Post Surgery:Three Months Post Surgery:Six Months to One Year Post Surgery:

    Timelime For Complete Recovery

    Soon after surgery, the patient is permitted to use the hand and wrist. The usual timelines for complete recovery are as follows:

    • Six weeks The patient may use the whole arm, including shoulder, for light activity.
    • Eight weeks The patient may begin unrestricted, active use of the arm and shoulder.
    • Three months Most patients are reasonably comfortable, have a range off motion about half of what is normal, and experience some weakness.
    • Six months Most patients are pain-free , and have motion and strength about two-thirds that of a normal level.
    • One year Approximately 95% of shoulder replacement patients will be pain-free. The remaining 5% will usually have no more than a weather-related ache or an occasional pain due to excessive activity. Likewise, there will probably not be significant strength limitations, depending on the condition of the deltoid and rotator cuff, particularly if both these muscle groups were normal before surgery.

    Shoulder Replacement Works Better For Older Patientsbut Complications Painkiller Use And Complications Are Still A Concern To Surgeons

    Here are the bullet points to recent medical studies:

    • Doctors in the United Kingdom write in the medical journal Shoulder and Elbow that the management of glenoid bone loss is a major challenge in both complex primary and revision arthroplasty surgery. 
    • Doctors writing in The Journal of Bone and Joint Surgery noted that shoulder surgery was seen as a further complication of rotator cuff disease. Secondary rotator cuff dysfunction is a recognized complication following shoulder arthroplasty. We hypothesized that the rate of secondary rotator cuff dysfunction would increase with follow-up and result in less satisfactory clinical and radiographic outcomes. 
    • A February 2020 update from the Hospital for Special Surgery journal offered this:
    • A total of 824 cases of revision shoulder arthroplasty were found. Eighty-seven patients had infections prior to revision and 133 patients had dislocations prior to revision. . .The most common complication of revision shoulder arthroplasty was found to be surgical site infection, affecting 10.9% of patients. In the time period studied, 89 patients underwent more than one revision shoulder arthroplasty.

    Risks Of Shoulder Replacement

    The risks of having complications vary from person to person. Thats because each persons health status is different. Complications differ as well, depending on the type of shoulder replacement being performed. While generally speaking, complications are uncommon, they are nonetheless, real risks that need to be heavily considered before deciding to proceed with surgery. Problems that can occur after shoulder replacement include:

    Infection

    Instability of the glenohumeral joint

    Dislocation most likely to occur during the healing process, which is why its important to wear the shoulder immobilizer Stiffness in the shoulder following your physical therapy routine can help prevent stiffness Component failure or loosening, which will lead to additional surgery Incomplete pain relief Nerve injury

    As with all surgery, there are also risks associated with undergoing general anesthesia, including heart attack, stroke, and even death.

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