All About Shoulder Replacement

Shoulder replacement is a surgical procedure in which all or part of the glenohumeral joint is replaced by a prosthetic implant.  Such joint replacement surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage.

Anatomy

Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The shoulder is a ball-and-socket joint: The ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade. This socket is called the glenoid.

The surfaces of the bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily

 A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the shoulder joint. In a healthy shoulder, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost any friction in your shoulder.

The muscles and tendons that surround the shoulder provide stability and support. All of these structures allow the shoulder to rotate through a greater range of motion than any other joint in the body.

Injury and diseases

Like any other joint, shoulder can be affected by injuries and joint specific diseases.

Fracture around shoulder Joint

The ball of the shoulder is a very dense bone in young but gets affected with osteoporosis with age, this weakens the bone. Also, the joint does not bear weight therefore it remains inherently weaker than the bones of the leg.

Therefore, when a person has a fall on his or her shoulder, despite the age it tends to break, that’s what we call a FRACTURE. Fracture of the shoulder ball is very disabling, and if not treated properly and quickly can cause stiffness and loss of function long term.

Treatment

If the fracture has not moved or is undisplaced as we call it, then simple sling, rest , ice and pain killers do the job.

If the fracture has moved, which is very likely the case , then treatment depends upon the amount the ball and joint has got affected. If the ball is strong as in young- Fixing the fracture with plate and screw is the right choice.

In elderly, sometimes the ball gets so much smashed that its difficult to reconstruct it with plates and screws. In those cases, replacing the ball remains the only option

Arthritis of Shoulder Joint

As in arthritis of the knee, here too the cushion or cartilage wears out, leading to narrowing of the joint. This causes friction between the two joint surfaces. It is the friction between two bones, which causes pain, swelling and difficulty in moving the shoulder. Studies indicate that it can affect up to 32% of people after the age of 60 years.

X-ray shows osteo arthritis Shoulder

Arthritic shoulder as seen during surgery

Treatment

In initial stages, pain killers, ice and sometimes injrctions into the joint with rehabilitation is all that is required.

If these do not help, or in very advanced stages; surgery with key hole or open technique may help. In advanced cases, one might have to change the ball or replace it

 WHAT IS SHOULDER REPLACEMENT

An orthopedic surgeon will replace the natural bone in the ball and socket of your shoulder joint with a material that could be metal or plastic. It’s a major surgery that’ll keep you in the hospital for several days. You’ll also need several weeks of physical therapy afterward.

There are three types of shoulder replacement surgeries:

• Total shoulder replacement: This is the most common type. It replaces the ball at the top of your humerus with a metal ball, which gets attached to the remaining bone. The socket gets covered with a new plastic surface.
• Hemi arthroplasy or Partial shoulder replacement:Only the ball gets replaced.
• Reverse shoulder replacement: Usually, you’d get this if you have a torn rotator cuff. It’s also done when another shoulder replacement surgery didn’t work. The metal ball gets attached to your shoulder bones, and a socket is implanted at the top of your arm.