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Do you suffer from shoulder pain? If so, you’re not alone. According to the American Academy of Orthopaedic Surgeons, approximately 7.5 million people visited a doctor’s office for a shoulder problem, including shoulder and upper arm sprains and strains, in a single year.
Considered the most flexible part of the body, a shoulder is a large ball and socket joint that is made up of bones, tendons, muscles and ligaments, which hold the shoulder in place while allowing movement. In a healthy shoulder, the rounded end of the upper arm bone (head of the humerus) glides against a small dish-like socket (glenoid) in the shoulder blade (scapula). Covered with smooth cartilage, these joint surfaces enable the shoulder to rotate in almost any direction (providing a full range of motion). Click here for a full shoulder diagram.
Shoulder injuries are frequently caused by athletic activities that involve excessive, repetitive, overhead motions, such as swimming, tennis, pitching and weightlifting. However, injuries can also occur during everyday activities, including washing walls, hanging curtains and gardening. Common shoulder injuries include:
- Ligament, tendon or muscle tears, including rotator cuff tears
- Bone fractures
- Frozen shoulders (adhesive capsulitis)
- Joint dislocations
The following diseases and disorders can also cause pain, stiffness and swelling in a shoulder, making even the simplest of movements difficult:
- Osteoarthritis (degenerative joint disease)
- Inflammatory (rheumatoid) arthritis
- Post-traumatic arthritis
- Death of bone tissue (osteonecrosis)
If you are experiencing pain in your shoulder, answer the following questions:
- Is your shoulder stiff? Y/N
- Can you only rotate your arm in a few directions? Y/N
- Is your shoulder’s range of motion limited? Y/N
- Does your shoulder feel like it pops or slides out of its socket? Y/N
- Do you lack strength in your shoulder to partake in your normal daily activities (i.e., reaching into a cupboard, dressing, etc.)? Y/N
If you answered “yes” to any of these questions, consult a physician to determine the severity of your shoulder issue and your treatment options.
During an initial consultation, a physician will review your current shoulder issue and your medical history. He/she will also conduct a physical examination to assess the swelling, tenderness, range of motion, strength/weakness, instability and/or deformity of your shoulder. Diagnostic testing, such as an X-ray, magnetic resonance imaging (MRI) or computed tomography (CT) scan may be needed. Once all of the test results are available, a physician will work with you to determine the best treatment option(s) for your specific shoulder condition.
Depending upon the cause and severity of your shoulder pain, there are several common non-surgical treatments that may lessen your symptoms. Please note, these should not serve as a substitute for a medical checkup or consultation with a physician.
- Rest: Resting your shoulder is essential to healing your shoulder. In short, if an activity hurts your shoulder, don’t partake in that activity until you consult with a physician.
- Ice: Applying an ice pack to your shoulder, for 15 minutes at a time, helps to reduce inflammation and relieve pain.
- Heat: Heat may soothe sore muscles, but will not reduce inflammation. Apply heat for 15 minutes at a time.
- Medication: Pain relief or anti-inflammatory medication may reduce shoulder pain.
- Electrical stimulation: Electrical stimulation, using a mild electric current that flows into your shoulder, can help reduce pain and swelling.
- Ultrasound: An ultrasound uses sound waves to loosen shoulder tightness and help reduce pain.
- Injection therapy: Injecting an anti-inflammatory medication directly into your shoulder may reduce pain and inflammation.
- Exercise: Stretching exercises may help increase flexibility, expand range of motion and relieve pain. Always consult with a physician before starting a new exercise regime.
If non-surgical treatments do not relieve your shoulder pain and/or stiffness, you may be a candidate for shoulder replacement surgery. Shoulder replacement surgery can alleviate pain and improve motion, strength and function. St. Luke’s Medical Center offers two primary types of shoulder replacement surgical procedures:
Total Shoulder Replacement
Most patients, especially those suffering from arthritis and tendon tears, are generally good candidates for total shoulder replacement procedures. During shoulder replacement surgery, all or part of a problem shoulder is replaced with an artificial joint, called a prosthesis. The prosthesis replaces joint surfaces with a highly polished metal ball attached to a stem and plastic socket (components are available in a variety of sizes).
Depending on the condition of the shoulder, the orthopedic surgeon may replace only the ball (sometimes, this decision is made in the operating room during surgery). If the bone is healthy, the orthopedic surgeon may choose to use a non-cemented or press-fitted humeral component. If the bone is soft, the humeral component may need to be implanted with bone cement. In most cases, an all-plastic glenoid component is implanted with bone cement. Implanting a glenoid component is not advisable in cases when there is good cartilage, the glenoid bone is severely deficient or the rotator cuff tendons are irreparably torn.
Reverse Total Shoulder Replacement
The reverse total shoulder replacement option is most effective for those suffering from completely torn rotator cuffs, severe arthritis and/or previously failed total shoulder replacements. For individuals experiencing these conditions, a conventional total shoulder replacement may not alleviate all of the pain and may not enable total rotation or arm movement past a 90-degree angle.
With the reverse total shoulder replacement procedure, the anatomy or structure of the healthy shoulder is reversed. The implant is designed so that the ball portion is attached to the shoulder blade (scapula) and the socket is placed at the upper end of the humerus.
Before Surgery
Two weeks before surgery, your surgeon may require that you stop taking non-steroidal anti-inflammatory medications (such as aspirin and ibuprofen) and most arthritis medications.
The Day of Surgery
After midnight before your surgery, you should not have anything to eat or drink. Your surgeon will discuss which specific medications to take the morning of surgery. An hour before surgery, you will be assessed in the preoperative area by a St. Luke’s Medical Center nurse anesthetist or anesthesiologist.
Shoulder replacement surgery is performed on an inpatient basis. Most patients are discharged from the hospital on the second or third day after the operation. Your surgeon will work with you to determine if you need an extended care facility or home assistance following hospitalization.
After Surgery
After shoulder replacement surgery, you should experience less pain and stiffness. You may also have more strength and movement in your shoulder and arm and be able to return to many of the activities you enjoy — such as golf, swimming, bowling, gardening and/or playing with your grandchildren. Your surgeon will help you to determine when you can return to work, as this will depend on your surgery and the type of work you do. Most patients are able to perform simple activities, such as eating, dressing and grooming, within two weeks after surgery. Driving a car is not allowed for at least six weeks after surgery.
A well-planned rehabilitation program is critical to the success of a shoulder replacement — beginning with physical therapy as early as the first day following your surgical procedure. Your surgery may recommend a few home exercises for you to complete during the first few weeks following surgery.
For more information about your shoulder surgery options at St. Luke’s Medical Center, call 1-877-351-WELL (9355).
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