
SHOULDER SURGERY

	SHOULDER ARTHROSCOPY ARTHROSCOPIC ACROMIOPLASTY ROTATOR CUFF REPAIR TOTAL SHOULDER REPLACEMENT TYPES OF SHOULDER SURGERY
SHOULDER CONDITIONS

	COMPARTMENT SYNDROME SHOULDER ARTHRITIS BURSITIS OF THE SHOULDER SHOULDER TENDONITIS ERB'S PALSY FROZEN SHOULDER SHOULDER FRACTURES ROTATOR CUFF TENDONITIS SHOULDER IMPINGEMENT SHOULDER SPRAINS & STRAINS SHOULDER DISLOCATION
PATIENT RESOURCES

	FREQUENTLY ASKED QUESTIONS BEFORE SHOULDER SURGERY AFTER SHOULDER SURGERY ANATOMY OF THE SHOULDER SHOULDER SURGERY GLOSSARY

Arthritis of the Shoulder

Arthritis is a condition that occurs in various joints in the body, especially in the knees, hips, and spine. It can affect any joint, but the shoulder is affected infrequently. When arthritis occurs, the cartilage that covers the ends of the bones making up the joint breaks down and often flakes off into the joint. The joint becomes swollen and stiff, and the lining tissue of the joint (the synovium) becomes overgrown. Frequently, spurs will develop around the margins of the joint and can, sometimes, break off inside. The pain can vary from mild to very severe, depending upon many factors, including the severity of the disease, the type of arthritis (most are wear and tear, or degenerative arthritis, but some are caused by rheumatoid disease) and the activity level.

Who usually gets arthritis?

Anyone can develop arthritis, but it most often occurs in middle aged patients and senior citizens. The condition may occur spontaneously or as a late result of previous trauma, such as fracture or dislocation. It also may occur as a result of an inflammatory disease such as rheumatoid arthritis.

CAUSE - Three major types of arthritis generally affect the shoulder.

Osteoarthritis - Osteoarthritis, or "wear-and-tear" arthritis, is a degenerative condition that destroys the smooth outer covering (articular cartilage) of bone. It usually affects people over 50 years of age and is more common in the acromioclavicular joint than in the glenohumeral shoulder joint.
Rheumatoid Arthritis - Rheumatoid arthritis is a systemic inflammatory condition of the joint lining, or synovium. It can affect people of any age and usually affects multiple joints on both sides of the body.
Posttraumatic Arthritis - Posttraumatic arthritis is a form of osteoarthritis that develops after an injury, such as a fracture or dislocation of the shoulder. Arthritis can also develop after a rotator cuff tear.

How do I know if I have arthritis?

The shoulder joint becomes stiff, feels heavy, and fatigues easily when arthritis is present. The stiffness is usually worse in the morning, and can slowly improve with "warm up activities." Also, grinding and catching in the shoulder is a common sign of arthritis.

DIAGNOSIS - A physical examination and X-rays are needed to properly diagnose arthritis of the shoulder.
During the physical examination, your physician will look for:

Weakness (atrophy) in the muscles
Tenderness to touch
Extent of passive (assisted) and active (self-directed) range of motion
Any signs of injury to the muscles, tendons, and ligaments surrounding the joint
Signs of previous injuries
Involvement of other joints (an indication of rheumatoid arthritis)
Crepitus (a grating sensation inside the joint) with movement
Pain when pressure is placed on the joint
X-rays of an arthritic shoulder will show a narrowing of the joint space, changes in the bone, and the formation of bone spurs (osteophytes).

If an injection of a local anesthetic into the joint temporarily relieves the pain, the diagnosis is supported.

TREATMENT - Treatment begins with conservative measures including anti-inflammatory medications, rest, ice, and physical therapy. Injections of cortisone can be therapeutic. If conservative options aren’t effective, surgery can be beneficial. The definitive treatment for advanced arthritis of the shoulder joint is a total shoulder replacement.

The surgery involves replacing the worn-down humeral head with a metal ball and the glenoid with a polyethylene socket. By three months after surgery, patients usually have significantly less pain and their motion is about half normal.

PREPARATION - Except for emergency reasons, your surgery will be scheduled in advance. Knowing the date of your operation, you will have enough time to prepare and plan for any special help you might need following discharge from the hospital. The average length of stay in the hospital for a total shoulder replacement is two to three days.

It is important to have a partner to assist you with your home exercises following discharge. Your partner should accompany you to physical therapy at least once or twice during your hospital stay.
You should discontinue use of any anti-inflammatory medication, including aspirin, one week before surgery.

Check with your doctor before discontinuing use of any medication.

A series of pre-operative tests will be scheduled one to two weeks before surgery. They will usually include: blood tests, an electrocardiogram (EKG) or test that records electrical activity of the muscle, a physical examination, a visit with your orthopedic surgeon and anesthesiologist (the physician that will administer pain medication during the procedure). You will receive your routing schedule by mail.

Most patients spend the night before surgery either at home or in a hotel nearby. They are then admitted to the hospital the next morning. This method of admission is called TCI - "to come in." This allows you to be with your family the night before your surgery. Your surgeon will inform you of your scheduled surgery appointment time and where to go to within the hospital on the day of the surgery.