Anatomy
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).
The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. Where the head of the humerus fits into the scapula is called the glenohumeral joint. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff. There is a second joint in the shoulder call the acromioclavicular joint. This joint commonly has arthritis within it but usually does not require surgery for treatment.
The rotator cuff is made up of four muscles that surround the humeral head (the ball of the shoulder). These muscles are attached to the bone by tendons that blend together to form a cuff that surrounds the ball. When the rotator cuff muscles contract, their combined action centers the ball in deepest portion of the shoulder socket. This centering effect is essential for normal shoulder function and allows the arm to be positioned in an incredibly wide range of motion with both strength and stability.
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).
The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. Where the head of the humerus fits into the scapula is called the glenohumeral joint. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff. There is a second joint in the shoulder call the acromioclavicular joint. This joint commonly has arthritis within it but usually does not require surgery for treatment.
The rotator cuff is made up of four muscles that surround the humeral head (the ball of the shoulder). These muscles are attached to the bone by tendons that blend together to form a cuff that surrounds the ball. When the rotator cuff muscles contract, their combined action centers the ball in deepest portion of the shoulder socket. This centering effect is essential for normal shoulder function and allows the arm to be positioned in an incredibly wide range of motion with both strength and stability.
Arthritis can also develop after a large, long-standing rotator cuff tear. The torn rotator cuff can no longer hold the head of the humerus in the glenoid socket, and the humerus can move upward and rub against the acromion. This can damage the surfaces of the bones, causing arthritis to develop with resultant significant symptoms.
The combination of a large rotator cuff tear and advanced arthritis can lead to severe pain and weakness, and the patient may not be able to lift the arm away from the side.
With increasing age the rotator cuff is prone to tear. Tears can occur from an acute, sudden injury, from accumulated damage over time, and from tendon weakening that occurs from the aging process. If tears go untreated, they may progress and enlarge over time to involve a substantial portion of the rotator cuff. When two or more tendons are involved, cuff tears are considered massive. Such tears have a major impact on both shoulder strength and stability, as well as causing severe shoulder pain. Strength is impaired because the muscle is no longer attached to the bone. Stability is impaired because the cuff can no longer center the ball in the socket. As a result, the humeral head drifts upward in the socket until it abuts against the acromion bone. Over time, this abnormal relationship between the ball and socket leads to erosion of the upper lip of the socket and arthritis ensues.
The combination of a large rotator cuff tear and advanced arthritis can lead to severe pain and weakness, and the patient may not be able to lift the arm away from the side.
With increasing age the rotator cuff is prone to tear. Tears can occur from an acute, sudden injury, from accumulated damage over time, and from tendon weakening that occurs from the aging process. If tears go untreated, they may progress and enlarge over time to involve a substantial portion of the rotator cuff. When two or more tendons are involved, cuff tears are considered massive. Such tears have a major impact on both shoulder strength and stability, as well as causing severe shoulder pain. Strength is impaired because the muscle is no longer attached to the bone. Stability is impaired because the cuff can no longer center the ball in the socket. As a result, the humeral head drifts upward in the socket until it abuts against the acromion bone. Over time, this abnormal relationship between the ball and socket leads to erosion of the upper lip of the socket and arthritis ensues.
Imaging
The X-ray to the left below shows a normal shoulder. The ball is round and is centered within the socket. The X-ray to the right below shows a shoulder with cuff tear arthropathy. The ball has risen upward causing erosion of the upper socket and abrasion against the acromion bone. The humeral ball has been rounded off and flattened from this abrasion.
The X-ray to the left below shows a normal shoulder. The ball is round and is centered within the socket. The X-ray to the right below shows a shoulder with cuff tear arthropathy. The ball has risen upward causing erosion of the upper socket and abrasion against the acromion bone. The humeral ball has been rounded off and flattened from this abrasion.
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Other changes occur around the shoulder joint that complicate the management of this condition. First, as a result of a long-standing tear, the rotator cuff muscles atrophy and are replaced by fat. Second, torn tendons undergo further degeneration and thinning both from disuse and abrasion. Third, the bone of the humeral head weakens from disuse. These changes generally make it impossible to repair the rotator cuff, classifying such tears as “irreparable.” With time, the bone of the humeral head may become so weak that collapse of the head occurs and the ball loses its smooth round joint surface.
Causes/Risk Factors
Not all massive rotator cuff tears result in cuff tear arthropathy. Some people with massive tears maintain well-compensated shoulder function despite the absence of an intact rotator cuff. The factors that cause certain patients to develop arthritis are not fully understood but it most likely represents a combination of abnormal joint mechanics from upward migration of the ball and loss of joint nutrition from leakage of joint fluid away from the cartilage. Currently we cannot predict which tears will progress to cuff tear arthropathy, nor have we identified any specific risk factors for its development. A more general risk factor is age. As we age, our tendons lose strength because their internal ability to heal and regenerate decreases. Damage that accumulates from repetitive use therefore is more likely to result in a tear compared to younger patients whose tendons are stronger.
Not all massive rotator cuff tears result in cuff tear arthropathy. Some people with massive tears maintain well-compensated shoulder function despite the absence of an intact rotator cuff. The factors that cause certain patients to develop arthritis are not fully understood but it most likely represents a combination of abnormal joint mechanics from upward migration of the ball and loss of joint nutrition from leakage of joint fluid away from the cartilage. Currently we cannot predict which tears will progress to cuff tear arthropathy, nor have we identified any specific risk factors for its development. A more general risk factor is age. As we age, our tendons lose strength because their internal ability to heal and regenerate decreases. Damage that accumulates from repetitive use therefore is more likely to result in a tear compared to younger patients whose tendons are stronger.
Symptoms and Signs
Symptoms
Severe pain and poor shoulder function are the hallmarks of this condition. Pain is generally aggravated by use but as the arthritis worsens, many patients will develop pain at rest as well. Night pain is also a typical feature and patients may awaken several times each night from pain. Shoulder function is affected both by pain but also by mechanical failure of the joint. With any attempt to raise the arm, the humeral head migrates upward out of the center of the socket. Without a stable platform for movement, the remaining shoulder muscles are unable to elevate the arm. Thus, many patients develop “pseudo-paralysis” due to almost complete inability to lift the arm away from the side. Inward and outward rotation may also be severely restricted depending on the specific tendons torn.
Signs
Cuff tear arthropathy is generally easy to identify by physical examination. Muscle atrophy results in characteristic wasting about the posterior shoulder girdle. Rotation of the joint causes pain and grinding of the ball against both the socket and acromion. Active elevation of the arm results in a classic “shoulder hike” as patients attempt to use the trapezius muscle to lift the arm away from the body by shrugging the shoulder. Finally, many patients will have a rupture of the biceps tendon. While these are the typical features of a massive rotator cuff tear, every patient may be affected differently. Despite a massive tear, some patients are able to actively elevate the arm by recruiting the deltoid and other muscles about the shoulder girdle.
Symptoms
Severe pain and poor shoulder function are the hallmarks of this condition. Pain is generally aggravated by use but as the arthritis worsens, many patients will develop pain at rest as well. Night pain is also a typical feature and patients may awaken several times each night from pain. Shoulder function is affected both by pain but also by mechanical failure of the joint. With any attempt to raise the arm, the humeral head migrates upward out of the center of the socket. Without a stable platform for movement, the remaining shoulder muscles are unable to elevate the arm. Thus, many patients develop “pseudo-paralysis” due to almost complete inability to lift the arm away from the side. Inward and outward rotation may also be severely restricted depending on the specific tendons torn.
Signs
Cuff tear arthropathy is generally easy to identify by physical examination. Muscle atrophy results in characteristic wasting about the posterior shoulder girdle. Rotation of the joint causes pain and grinding of the ball against both the socket and acromion. Active elevation of the arm results in a classic “shoulder hike” as patients attempt to use the trapezius muscle to lift the arm away from the body by shrugging the shoulder. Finally, many patients will have a rupture of the biceps tendon. While these are the typical features of a massive rotator cuff tear, every patient may be affected differently. Despite a massive tear, some patients are able to actively elevate the arm by recruiting the deltoid and other muscles about the shoulder girdle.
Diagnosis
In some cases, the patient’s history and physical exam may be all that is necessary to make a diagnosis of a cuff tear arthopathy. Nevertheless, imaging studies are important to assess the degree of arthritis, and bony relationships.
Plain X-rays are essential to confirm the diagnosis. When these show upward migration of the ball in the socket, a massive, irreparable rotator cuff tear is present. These x-rays also show the degree to which the ball has worn against the upper part of the socket and the undersurface of the acromion. In addition, they show if the ball has undergone any collapse from severe osteoporosis.
If the X-rays suggest that significant wear has occurred against the acromion undersurface, a CT scan may be necessary to look for the presence of an acromion stress fracture. A CT scan is a special study that takes multiple x-rays in 3 dimensions and provides greater detail of the bone structure. CT scans also provide more detailed information about the relationship of the ball to the socket and about the pattern of socket wear and erosion.
MRI scans are generally not necessary in cases of true cuff tear arthropathy. While MRIs are useful in looking at the rotator cuff tendons, such information is irrelevant in the presence of an irreparable tear. This can be determined by upward migration of the ball on the regular x-ray. If the ball remains centered in the socket but patients present with severe weakness of arm elevation, then an MRI is useful determine if the tear is repairable. This determination is made based on tear size, tendon retraction and the degree of muscle atrophy.
In some cases, the patient’s history and physical exam may be all that is necessary to make a diagnosis of a cuff tear arthopathy. Nevertheless, imaging studies are important to assess the degree of arthritis, and bony relationships.
Plain X-rays are essential to confirm the diagnosis. When these show upward migration of the ball in the socket, a massive, irreparable rotator cuff tear is present. These x-rays also show the degree to which the ball has worn against the upper part of the socket and the undersurface of the acromion. In addition, they show if the ball has undergone any collapse from severe osteoporosis.
If the X-rays suggest that significant wear has occurred against the acromion undersurface, a CT scan may be necessary to look for the presence of an acromion stress fracture. A CT scan is a special study that takes multiple x-rays in 3 dimensions and provides greater detail of the bone structure. CT scans also provide more detailed information about the relationship of the ball to the socket and about the pattern of socket wear and erosion.
MRI scans are generally not necessary in cases of true cuff tear arthropathy. While MRIs are useful in looking at the rotator cuff tendons, such information is irrelevant in the presence of an irreparable tear. This can be determined by upward migration of the ball on the regular x-ray. If the ball remains centered in the socket but patients present with severe weakness of arm elevation, then an MRI is useful determine if the tear is repairable. This determination is made based on tear size, tendon retraction and the degree of muscle atrophy.
Natural History and Treatment
There is currently no way to predict if and when patients with a massive, irreparable rotator cuff tear will develop arthritis. Such cases of true cuff tear arthropathy represent the end-stage of only about 10% of rotator cuff tears. When this degenerative process occurs, progressive wear and erosion of the socket and acromion occur and osteoporosis of the humeral head may ultimately result in collapse and severe deformity. Most patients seek treatment before collapse occurs. While some patients reach a plateau in terms of pain and loss of function, some patients continue to decline with progressive disability.
There is currently no way to predict if and when patients with a massive, irreparable rotator cuff tear will develop arthritis. Such cases of true cuff tear arthropathy represent the end-stage of only about 10% of rotator cuff tears. When this degenerative process occurs, progressive wear and erosion of the socket and acromion occur and osteoporosis of the humeral head may ultimately result in collapse and severe deformity. Most patients seek treatment before collapse occurs. While some patients reach a plateau in terms of pain and loss of function, some patients continue to decline with progressive disability.
Non-operative Treatment
Physical Therapy
Therapy may be successful in patients with well-compensated shoulder function and pain that is at a manageable level. The goals are to improve shoulder flexibility and strengthen the muscles around the shoulder girdle that compensate for the torn cuff. These muscles are called the scapular stabilizers and include the serratus anterior, trapezius, rhomboids, latissimus dorsi, and pectoralis major. In addition, deltoid strengthening may improve shoulder function.
Aquatherapy may prove beneficial in allowing patients to exercise in a relatively weightless environment. Water helps support the joint and is also soothing for the sore shoulder.
Physical therapy is less effective in patients with poor function and moderate to severe pain. In these cases, painful abrasion of the bones limits what can be accomplished through range of motion and strengthening exercises.
Non-steroidal Anti-inflammatory Medications (NSAIDS)
These medicines include Ibuprofen, Motrin, Advil, Alleve, Celebrex, and others. They reduce inflammation and also act as mild pain relievers. They may provide some relief and help keep some patients at a manageable level. In other cases, the arthritis may be severe enough that these medications are of little benefit. Long-term use of NSAIDS may be associated with risks such as irritation of the stomach lining, ulcers, and kidney problems. Patients should become informed about the possible short- and long-term side effects of each medication prior to use. This is especially true for patients who take other medications for blood pressure, heart problems, diabetes, etc.
Other Medications
Narcotic pain medications, muscle relaxants, and sleeping pills are generally not recommended for rotator cuff tear arthropathy syndrome as prolonged use may diminish their effectiveness and may cause medication dependence or even addiction.
Cortisone Injections. Cortisone is a powerful anti-inflammatory medication that can be injected directly into the shoulder so that it acts locally on the inflamed joint. These injections can provide fairly dramatic pain relief. Their duration of effect is variable and there is no way to predict how long each injection will last. Patients who have had several injections may find that these shots lose their effectiveness. In general, most patients can expect relief to last anywhere between 1 to 4 months, sometimes longer.
Cortisone injections are generally well tolerated and have minimal side effects. In patients with diabetes, cortisone shots may temporarily elevate the blood sugar and careful glucose level monitoring is recommended for the first few days after treatment. Repeated injections may cause some weakening of the surrounding bone and we generally try to space injections out every 4-6 months.
Physical Therapy
Therapy may be successful in patients with well-compensated shoulder function and pain that is at a manageable level. The goals are to improve shoulder flexibility and strengthen the muscles around the shoulder girdle that compensate for the torn cuff. These muscles are called the scapular stabilizers and include the serratus anterior, trapezius, rhomboids, latissimus dorsi, and pectoralis major. In addition, deltoid strengthening may improve shoulder function.
Aquatherapy may prove beneficial in allowing patients to exercise in a relatively weightless environment. Water helps support the joint and is also soothing for the sore shoulder.
Physical therapy is less effective in patients with poor function and moderate to severe pain. In these cases, painful abrasion of the bones limits what can be accomplished through range of motion and strengthening exercises.
Non-steroidal Anti-inflammatory Medications (NSAIDS)
These medicines include Ibuprofen, Motrin, Advil, Alleve, Celebrex, and others. They reduce inflammation and also act as mild pain relievers. They may provide some relief and help keep some patients at a manageable level. In other cases, the arthritis may be severe enough that these medications are of little benefit. Long-term use of NSAIDS may be associated with risks such as irritation of the stomach lining, ulcers, and kidney problems. Patients should become informed about the possible short- and long-term side effects of each medication prior to use. This is especially true for patients who take other medications for blood pressure, heart problems, diabetes, etc.
Other Medications
Narcotic pain medications, muscle relaxants, and sleeping pills are generally not recommended for rotator cuff tear arthropathy syndrome as prolonged use may diminish their effectiveness and may cause medication dependence or even addiction.
Cortisone Injections. Cortisone is a powerful anti-inflammatory medication that can be injected directly into the shoulder so that it acts locally on the inflamed joint. These injections can provide fairly dramatic pain relief. Their duration of effect is variable and there is no way to predict how long each injection will last. Patients who have had several injections may find that these shots lose their effectiveness. In general, most patients can expect relief to last anywhere between 1 to 4 months, sometimes longer.
Cortisone injections are generally well tolerated and have minimal side effects. In patients with diabetes, cortisone shots may temporarily elevate the blood sugar and careful glucose level monitoring is recommended for the first few days after treatment. Repeated injections may cause some weakening of the surrounding bone and we generally try to space injections out every 4-6 months.
Surgery for Rotator Cuff Tear Arthropathy
The principle goal of surgery is pain relief with a secondary goal of improved function. No attempt is made to repair the rotator cuff. Surgery is considered when:
The principle goal of surgery is pain relief with a secondary goal of improved function. No attempt is made to repair the rotator cuff. Surgery is considered when:
- Cuff tear arthropathy results in substantial pain and loss of function that has not responded to non-operative measures.
- One’s quality of life is sufficiently impaired to consider surgery.
- One is sufficiently healthy to undergo the procedure.
- One understands and accepts the risks and alternatives.
- The surgeon is experienced in the surgical techniques and their indications.
Urgency of Surgery
Shoulder replacement surgery for cuff tear arthropathy is an elective procedure that can be scheduled when circumstances are optimal for the patient. It is not an urgent procedure. The patient has plenty of time to become informed about the process of surgery and recovery.
Factors that the patient should consider in choosing the optimal time include the following:
Shoulder replacement surgery for cuff tear arthropathy is an elective procedure that can be scheduled when circumstances are optimal for the patient. It is not an urgent procedure. The patient has plenty of time to become informed about the process of surgery and recovery.
Factors that the patient should consider in choosing the optimal time include the following:
- The cuff tear arthropathy has become sufficiently disabling to impair the performance of daily activities. Patients who are still able to sleep comfortably and manage daily activities may and probably should consider waiting.
- A planned period of time can be specifically dedicated to the recovery and rehabilitation process that will not interfere with other scheduled events.
- Overall health and nutritional status are optimal and will not limit the ability to comply with the performance of rehabilitation.
Recommended Surgeries
Reverse Total Shoulder Arthroplasty
This operation is intended for patients who have developed instability and/or severe shoulder dysfunction from cuff tear arthropathy where attempts to elevate the arm results in dislocation of the ball from the socket or the arm cannot be lifted away from the body at all. These patients have sometimes undergone resection of part of the acromion bone as part of a previous rotator cuff tear. The reverse prosthesis is an excellent treatment option for patients with pseudoparalysis of the shoulder who have poorly compensated function. Click here to see a patient in action who has reverse total shoulder arthroplasty surgery.
As the title describes, in this operation an artificial ball is placed against the socket and an artificial socket is used to replace the ball. This constrains the ball and socket so that dislocation does not occur. By reversing this relationship, the deltoid muscle is able to elevate the arm in the absence of a rotator cuff. This operation requires that the socket has sufficient bone to place the prosthetic ball. This is frequently determined with a preoperative CT scan.
Recovery from this operation also involves immediate range of motion exercises and early strengthening of the deltoid muscle. Continuous passive motion is not used in these cases, rather patients are started in early outpatient therapy for range of motion and strengthening exercises.
Reverse Total Shoulder Arthroplasty
This operation is intended for patients who have developed instability and/or severe shoulder dysfunction from cuff tear arthropathy where attempts to elevate the arm results in dislocation of the ball from the socket or the arm cannot be lifted away from the body at all. These patients have sometimes undergone resection of part of the acromion bone as part of a previous rotator cuff tear. The reverse prosthesis is an excellent treatment option for patients with pseudoparalysis of the shoulder who have poorly compensated function. Click here to see a patient in action who has reverse total shoulder arthroplasty surgery.
As the title describes, in this operation an artificial ball is placed against the socket and an artificial socket is used to replace the ball. This constrains the ball and socket so that dislocation does not occur. By reversing this relationship, the deltoid muscle is able to elevate the arm in the absence of a rotator cuff. This operation requires that the socket has sufficient bone to place the prosthetic ball. This is frequently determined with a preoperative CT scan.
Recovery from this operation also involves immediate range of motion exercises and early strengthening of the deltoid muscle. Continuous passive motion is not used in these cases, rather patients are started in early outpatient therapy for range of motion and strengthening exercises.
This is a relatively new procedure that few surgeons are trained to perform. Dr. Jurek trained specifically in her shoulder fellowship to perform this procedure.
A reverse total shoulder replacement works better for people with cuff tear arthropathy because it relies on different muscles — not the rotator cuff — to move the arm.
Shoulder Arthroscopy with Rotator Cuff and Glenohumeral Joint Debridement (Smooth and Move Procedure)
This operation is considered in patients with an irreparable rotator cuff tear in whom significant erosion of the upper socket has not yet occurred. These patients tend to be earlier in the course of the disease and have substantial loss of shoulder function and pain without significant arthritis.
The goal of treatment is to clear away any remaining inflamed tendon tissue that causes mechanical abrasion and to release any scar tissue that prevents a full range of motion. In addition, any rough areas of bone on the humeral head are contoured and rounded off so that the ball glides smoothly beneath the acromion bone. This operation can be done through a relatively small incision on the outside of the shoulder. It does not violate any muscle attachments so that recovery is accelerated.
Postoperatively, patients are permitted immediate full use of the arm. Post-operative physical therapy is aimed at preserving range of motion and strengthening the shoulder girdle muscles that compensate for the torn rotator cuff. Outpatient physical therapy is frequently helpful in optimizing recovery after this procedure.
Partial Shoulder Replacement (Hemiarthroplasty)
This operation is geared toward patients with an irreparable rotator cuff who have disabling pain from abrasion of the humeral head against the arthritic socket and acromion bone. Unlike the Smooth and Move Operation, this surgery address the arthritis that has developed between the ball and upper socket Through an incision on the front of the shoulder, an artificial ball with a smooth round metal head is inserted onto a metal stem that fits in the canal of the humerus bone. This ball reduces the friction and abrasion against the arthritic socket and acromion from bone-on-bone contact. Unlike a total shoulder replacement, the socket is not replaced in cuff tear arthropathy because of a high risk of socket loosening. There are certain conditions that make this surgery an excellent choice for certain patients, but frequently, a reverse total shoulder arthroplasty is the treatment of choice when it comes to a replacement shoulder surgery to treat rotator cuff tear arthropathy.
Postoperatively, patients are started on immediate gentle range of motion exercises. This operation is effective in diminishing pain from the arthritis but does not guarantee any improvement in shoulder strength or the ability to lift the arm (the reverse total shoulder arthroplasty is much more reliable in achieving improvement in shoulder strength and the ability to lift the arm).
A reverse total shoulder replacement works better for people with cuff tear arthropathy because it relies on different muscles — not the rotator cuff — to move the arm.
Shoulder Arthroscopy with Rotator Cuff and Glenohumeral Joint Debridement (Smooth and Move Procedure)
This operation is considered in patients with an irreparable rotator cuff tear in whom significant erosion of the upper socket has not yet occurred. These patients tend to be earlier in the course of the disease and have substantial loss of shoulder function and pain without significant arthritis.
The goal of treatment is to clear away any remaining inflamed tendon tissue that causes mechanical abrasion and to release any scar tissue that prevents a full range of motion. In addition, any rough areas of bone on the humeral head are contoured and rounded off so that the ball glides smoothly beneath the acromion bone. This operation can be done through a relatively small incision on the outside of the shoulder. It does not violate any muscle attachments so that recovery is accelerated.
Postoperatively, patients are permitted immediate full use of the arm. Post-operative physical therapy is aimed at preserving range of motion and strengthening the shoulder girdle muscles that compensate for the torn rotator cuff. Outpatient physical therapy is frequently helpful in optimizing recovery after this procedure.
Partial Shoulder Replacement (Hemiarthroplasty)
This operation is geared toward patients with an irreparable rotator cuff who have disabling pain from abrasion of the humeral head against the arthritic socket and acromion bone. Unlike the Smooth and Move Operation, this surgery address the arthritis that has developed between the ball and upper socket Through an incision on the front of the shoulder, an artificial ball with a smooth round metal head is inserted onto a metal stem that fits in the canal of the humerus bone. This ball reduces the friction and abrasion against the arthritic socket and acromion from bone-on-bone contact. Unlike a total shoulder replacement, the socket is not replaced in cuff tear arthropathy because of a high risk of socket loosening. There are certain conditions that make this surgery an excellent choice for certain patients, but frequently, a reverse total shoulder arthroplasty is the treatment of choice when it comes to a replacement shoulder surgery to treat rotator cuff tear arthropathy.
Postoperatively, patients are started on immediate gentle range of motion exercises. This operation is effective in diminishing pain from the arthritis but does not guarantee any improvement in shoulder strength or the ability to lift the arm (the reverse total shoulder arthroplasty is much more reliable in achieving improvement in shoulder strength and the ability to lift the arm).
Risks of Surgery
The risks of shoulder replacement surgery include but are not limited to the following: infection, injury to nerves and blood vessels, fracture, stiffness or instability of the joint, pain, and the need for additional surgeries. There are also risks of anesthesia and blood transfusion (although transfusions are not frequently necessary). An experienced shoulder joint replacement team will use special techniques to minimize these risks, but cannot totally eliminate them.
The risks of shoulder replacement surgery include but are not limited to the following: infection, injury to nerves and blood vessels, fracture, stiffness or instability of the joint, pain, and the need for additional surgeries. There are also risks of anesthesia and blood transfusion (although transfusions are not frequently necessary). An experienced shoulder joint replacement team will use special techniques to minimize these risks, but cannot totally eliminate them.
Recovery and Rehabilitation
Early motion after shoulder replacement surgery helps achieve the best possible shoulder function. Early motion is facilitated by the complete surgical release of the tight tissues so that after surgery the patient has only to maintain the range of motion achieved at the operation. However, after surgery, scar tissue will tend to recur and limit movement unless motion is started immediately. Early motion also stimulates recovery of muscle function. During the hospitalization, the patient learns a simple rehabilitation program that will be used for maintaining the range of motion after discharge.
Once the shoulder has healed from the surgery, physical therapy is usually initiated. This is typically started at six weeks after surgery. Sometimes physical therapy is not needed; this will be discussed with your surgeon at your clinic followup visit.
Early motion after shoulder replacement surgery helps achieve the best possible shoulder function. Early motion is facilitated by the complete surgical release of the tight tissues so that after surgery the patient has only to maintain the range of motion achieved at the operation. However, after surgery, scar tissue will tend to recur and limit movement unless motion is started immediately. Early motion also stimulates recovery of muscle function. During the hospitalization, the patient learns a simple rehabilitation program that will be used for maintaining the range of motion after discharge.
Once the shoulder has healed from the surgery, physical therapy is usually initiated. This is typically started at six weeks after surgery. Sometimes physical therapy is not needed; this will be discussed with your surgeon at your clinic followup visit.
This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon.