Arthritis

ARTHRITIS OF THE SHOULDER
There are 2 bony articulations or joints in the shoulder complex where osteoarthritis can occur.

a) The glenohumeral articulation between the humerus and the glenoid
b) The acromioclavicular joint between the acromium and clavicle.

THE HEAD OF THE HUMERUS HAS BECOME FLATTENED BY DEGENERATIVE CHANGES

 

The inflammatory condition rheumatoid arthritis affects multiple joints, the shoulder being one of them.

 

THIS X RAY SHOWS EXTREME WEAR FROM CHANGES RELATED TO RHEUMATOID ARTHRITIS TO THE EXTENT THAT THE HUMERAL HEAD HAS FRACTURED

 

Signs and Symptoms

• Pain aggravated by activity, typically felt deep or behind the shoulder in cases of glenohumeral arthritis and in the front for acromioclavicular arthritis.
• Limited range of movement
• Weakness
• Pain to touch the shoulder
• Cracking/grating on movement.
• Pain on compression of the joint eg pushing up from a chair, leaning on elbows.

Treatment

• Change of activities to avoid provoking symptoms.
• Non Steroidal Anti Inflammatory Drugs and painkillers.NSAID
• Ice packs for 20 minutes 3 times a day to reduce inflammation.
• Physiotherapy to increase muscle strength and range of movement. Joint distractions and glides performed by the physiotherapist can be particularly helpful to increase movement.
• Surgery – either a partial resurfacing or stemmed total shoulder replacement.

LINK TO TSR SURG AND ‘OXFORD’ WHAT TO EXPECT FROM TSA
TOTAL SHOULDER REPLACEMENT-ROTATOR CUFF INTACT

Purpose

The purpose of this operation is to replace the articular surfaces of the humeral head and glenoid with prosthetic implants, to control pain and improve function.

Indications

All patients with pain from arthritis of the glenohumeral joint.and a rottor cuff that is intact.
Implants

Copy TSR with RCR

Skin Incision

A Deltopectoral approach is used

Possible Associated Procedures

-Acromioplasty and sub acromial decompression if sub acromial impingement co-exists
-Excision Hemiarthroplasty of the ACJ ( Acromioclavicular joint) if the joint is arthritic and symptomatic.

 

 

 

 

 

 

 

 

 

Main Possible Complications

1.Neurovasculuar
2Humeral Shaft or Humeral Fracture
3.Dissociation of implant components
4.Failure of Rotator Cuff

After your operation

-The arm will be rested in a controlled position in a sling or brace. The physiotherapist and nursing staff will show you how to adjust and safely remove and re-apply this.( link to living with a sling)
-An x ray will be taken the day after surgery.
-You will be able to return home when your pain is well controlled and you can cope with your arm in a sling, typically 2 days after surgery.
-You can expect to need painkillers for 2 or 3 weeks after surgery to control the background pain. You will also need to take painkillers an hour before each exercise /physiotherapy session ; ideally 3 times a day, for up to 8 weeks or even longer.
-You will be shown specific shoulder and arm exercises by your physiotherapist before you leave the hospital. These exercises are very important and must be carried out accurately after leaving the hospital on a daily basis at home; ideally 3 times a day.
-The stitches must be removed, or the wound inspected (if absorbable sutures are used) at 14 days after surgery; either with your GP’s practice nurse or at the hospital.

 

TOTAL SHOULDER REPLACEMENT WITH ROTATOR CUFF REPAIR

Purpose
To replace the damaged articular surfaces of the humeral head and glenoid with prosthetic implants to relieve pain and repair the rotator cuff to restore or improve range of movement and function.

Indications

Patients with pain from arthrosis or degenerative changes of the glenohumeral (shoulder ) joint with an additional,repairable Rotator Cuff tear.
Implants

Two implants are used; a humeral component, composed of a modular metal shaft with separate head components and a glenoid component made of polyethylene with or without a metal surface.

Skin Incisions

A deltopectoral incision is used .

DIAG here
Possible associated procedures

- Acromioplasty. This may be needed with sub acromial decompression if sub acromial impingement co-exists
- Excision hemiarthroplasty of the ACJ ( Acromioclavicular joint). If there are any degenerative changes of the Acromioclavicular joint which are symptomatic and causing pain this is required.

Main Possible Complications

-Infection
-Damage to nerve and blood vessels
-Humeral shaft or glenoid fracture
-Dislocation of implant components
-Arm vein thrombosis
-New shoulder joint stiffness
Possible complications are infection, damage to nerve and blood vessels, humeral shaft or glenoid fracture, dislocation of implant components, arm vein thrombosis, stiffnes of the new joint.
After your operation
-The arm will be rested in a controlled position in a sling or brace.The physiotherapist and nursing staff will show you how to adjust and safely remove this (link to living with a sling)
-An x ray will be taken the day after surgery.

-You will be able to return home when when your pain is well controlled and you can cope with your arm in the sling. This is typically 2 days after surgery.

-You can expect to need painkillers for 2 to 3 weeks after surgery to control any background pain. You will also need to take painkillers an hour before each exercise / physiotherapy session. You will need to do exercises for at least 8 weeks after surgery.

-You will be shown specific shoulder and arm exercises by your physiotherapist before you leave the hospital. These exercises are evry important and must be carried out accurately after leaving hospital on a daily basis at home: ideally 3 times a day.

-The stitches must be removed or the wound inspected ( if absorbable sutures are used) at 14 days after surgery: either by your GP’s practice nurse or at the hospital.
-Your surgeon will typically need to see you 4 weeks after surgery.