What is it?
Arthritis of the shoulder is a degenerative wear process of the smooth cartilage lining of the humeral head (ball) and glenoid (socket joint). The worn surfaces can then rub on each other causing pain. Arthritis of the shoulder is less common than arthritis affecting the hip or knee although the symptoms can be very disabling.
What are the symptoms?
The symptoms are of worsening deep-seated pain and stiffness, which develop over months to years. Pain is made worse with activity and often felt at night making sleeping difficult. Loss of motion in joint may make it difficult to carry out simple activities of daily living.
Will I need any further investigations?
X-rays are required to look for wear of the joint space and for the presence of osteophytes (bone spurs). CT scans allow for a more detailed assessment of the joint and are very useful when planning surgery.
What are the non-surgical treatment options?
Painkillers and anti-inflammatory medication may help reduce pain. It is sensible to modify or limit your activities with the arm to reduce the load on the shoulder. Cortisone injections into the shoulder joint may provide some temporary relief.
What does surgery involve?
Surgery (shoulder replacement) is reserved for patients that fail to improve with the above treatments. The operation removes the arthritic joint surfaces and replaces them with artificial components. The typical total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket. Sometimes it is not possible to replace the socket of the joint and in which case only the ball is replaced (hemiarthroplasty). Another type of shoulder replacement is called reverse total shoulder replacement. Reverse total shoulder replacement is used for people who have arthritis and non-functional rotator cuff. In reverse total shoulder replacements, the socket and metal ball are switched. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the rotator cuff to lift the arm.
What is the success of surgery?
Generally, this is a reliable operation to relieve your symptoms of pain and improve shoulder function although there are a number of risks and complications.
What are the potential risks of surgery?
Any surgical procedure carries risks, however every effort is made to minimise these to ensure the best possible outcome from your surgery. The risks of the operation include infection, bleeding, nerve damage, stiffness and dislocation. Further risks with a shoulder replacement relate to the artificial nature of the joint; although prosthesis designs and materials continue to advance, the prosthesis may wear down and the components may loosen. Excessive wear, loosening, or dislocation may require additional surgery (revision procedure). There is a risk of developing a blood clot in the arm that can go to the lungs, although the risk of this is extremely rare and significantly less than that from hip and knee surgery.
What is the recovery after surgery?
The shoulder will be protected in a sling after the operation for a period of 4 weeks. During this time you begin a supervised rehabilitation programme under the guidance of a physiotherapist. Physiotherapy is essential after the operation, to encourage good movement, rehabilitate the muscles back to normal function and ensure you are making good progress. You will see a therapist prior to discharge from the hospital. You will be given painkillers to take home after surgery. The use of an ice pack on the shoulder may also be helpful for the first few days after surgery. You will be seen in clinic two weeks after surgery to check the wounds and assess your progress. There are no sutures to be removed.
When can I return to normal activities?
Return to work depends on the nature of the job and your speed of recovery. You can return to desk and computer work when you feel comfortable to do so. You will be unable to drive for approximately 6 weeks. The timescale for which you can go back to any previous sport or activity will depend on your movement and strength and the particular activity you have in mind.