The shoulder is an amazing mechanism with a greater range of motion than any other joint in your body. It's a ball-and-socket joint that lets you raise, twist, and bend your arm – and move it forward, to the side, and behind you. Normally, the rounded end of the upper arm bone (head of the humerus) glides against the small dish-like socket (glenoid) in the shoulder blade (scapula). A smooth coating of cartilage allows the shoulder to rotate through its full range.
Almost everyone develops some form of osteoarthritis as we age (though it's diagnosed for some younger people as well). By the time we reach 50 years or older, the cushioning material (cartilage) is eroding away. Without that cushion, bones rub against each other, which can be very painful and cause stiffness.
This disease is the most common form of a group of conditions known as inflammatory arthritis. Unlike osteoarthritis, it is not caused by wear and tear over the years. With rheumatoid arthritis, material, called the synovial membrane, surrounding the joint becomes inflamed and thickened. In time, this causes loss of cartilage along with pain and stiffness.
This is caused by a serious injury, such as a bone fracture or tears in the shoulder ligaments. Again, the cause of the pain and stiffness is the loss of cartilage.
Rotator cuff tear
This is a combination of severe arthritis and a massive irreparable tear of the rotator cuff tendon..
Also known as avascular necrosis, aseptic necrosis, and ischemic necrosis, this disease results from the temporary or permanent loss of blood supply to the bones. It can collapse the joint. There are many causes of osteonecrosis – and one thing the clinicians at The Joint Program will look for in diagnosing your shoulder pain and determining the best treatment.
There is a very long list of diseases and injuries that affect the shoulder. Some of these require surgical intervention – others do not. They include gout, infections, bursitis, torn cartilage, frozen shoulder, and heat injury.
When should you see a doctor?
If you experience unusual pain, or have a decrease in your range of motion, it’s good to see your doctor. Call for an appointment if you:
- Feel weakness in your shoulder.
- Have trouble with your everyday or recreational activities such as lifting grocery bags or playing tennis.
- Experience swelling or bruising around the shoulder joint
- Have pain does not come and go – it hurts whether you are sitting or moving – it can even interrupt your sleep.
- Hurt when you raise your arm
With today’s medical advances, you don't need to live with pain, and you can play tennis and golf, work in your garden, ski – be active longer than you may suppose.
Of course, your doctor will have you try noninvasive treatments, such as rest, ice and heat, physical therapy, and medications. In some cases this may be all your shoulder needs to recover. But there are conditions that require complete shoulder replacement. Your condition will be evaluated at The Joint Center at the OICM:
Complete shoulder replacement
Shoulder replacement surgery, a subspecialty of orthopaedics, has progressed to include surgical techniques that allow the treatment of patients with conditions that previously had no satisfactory surgical solution. These conditions include instability, pseudo paralysis, facture management, and revising previous failed surgery for arthritis.
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. These components come in various sizes. They may be either cemented or "press fit" into the bone. In most cases, an all-plastic glenoid (socket) component is implanted with bone cement.
Reverse shoulder replacement
Until recently, procedures for patients with a deficient rotator cuff and/or advanced shoulder joint arthritis with bone and cartilage loss, offered limited outcomes. Traditional shoulder surgery – even total shoulder replacement – could not accomplish both mobility restoration and pain alleviation.
Now there’s a relatively new procedure called Reverse Shoulder Replacement, and it's being performed regularly through The Joint Program at the OICM. Quite literally, the replacement implant is reversed – putting the ball on the socket side and vice versa. This positioning allows the deltoid muscle to compensate for the torn or degenerated rotator cuff and restore the ability to fully lift the arm and do so without pain. It is not a procedure for everyone, but can provide pain-free mobility to patients who have not had success with traditional shoulder replacement.
Reverse shoulder replacement is not the answer for everyone with shoulder problems. The Joint Program surgeons work closely with the patient’s primary care physician to match the right procedure for the best outcome for each case.