Friday, 7 July 2017

Shoulder Replacement Surgery

It is important to realize that shoulder replacement surgery actually refers to the replacement of the shoulder joint and not the entire shoulder. It is a common procedure done to repair the damaged shoulder joint for various reasons.

Why would someone require shoulder replacement surgery?
The main reason for a shoulder replacement surgery is the pain, particularly intense pain that negatively affects an individual’s life. This prevents a person even from performing daily everyday tasks. The most common reason for the surgery is arthritis, which can either be in the form of rheumatoid arthritis or osteoarthritis. Rheumatoid arthritis is an autoimmune disorder that causes the immune system to attack the cartilage within the shoulder joint.

Osteoarthritis, on the other hand, is caused by an overuse of the shoulder joint, which usually develops with age. Osteoarthritis is also common in people who tend to use their shoulder very often as well. Regardless of the form of arthritis, it presents with pain because moving the shoulder begins to press against the nerves. There are medications that help to relieve the pain and inflammation. Shoulder replacement surgery can be done if the pain is severe.

If the pain can’t be controlled with over the counter painkillers, prescribed painkillers or other conservative treatment methods. The other major cause of shoulder pain that may require the surgery is trauma, such as in cases of a car accident where the parts of the shoulder joint are damaged. In these cases, surgery is perhaps the only treatment available for the damage to the shoulder joint may be extensive.

Shoulder replacement surgery is a fairly common surgery, and it has been performed since the 1950s. However, it’s still not as common as knee and hip replacement surgeries.

How is the surgery done?
To understand how the surgery is performed, it’s important to know the structure of the shoulder joint. It is a ball and socket joint – the end of the humerus of the upper arm is ball-shaped and it fits into the glenoid. This is a socket-shaped and found at the end of the shoulder blade (scapula). For smooth motion, both the humerus and the scapula are lined with cartilage which allows the bones to glide and move once the shoulder joint is moved.

Tying everything together are tendons and muscles. If any of these parts are damaged, there mild, moderate or severe pain is experienced, accompanied by difficulties moving the joint, etc. In these cases, surgical treatment is required, especially when conservative treatment has failed to relieve the signs and symptoms of shoulder joint problem. For the surgery, the end of the humerus and the glenoid are replaced with artificial substances – plastic and metal.

For binding, a kind of cement is used or alternative materials can be placed that allow the bone to grow naturally. The end of the humerus is usually drilled with a piece of metal to strengthen the bone, especially if the damage is severe. In less serious cases, it can just be lined with plastic. As for the glenoid, it can be smoothed using plastic only or a combination of plastic and metal.

It is a serious surgery that usually requires general anesthesia, although sometimes local anesthesia alone can be used. After the surgery, you will need to rest the joint so that the damaged muscles and tendons around the joint can heal and fully recover. When this process is done, physical therapy can then begin to allow you to learn to use your shoulder again and provide you with the best range of motion possible.

Just like any other surgical procedure, shoulder replacement surgery has its own risks and possible complications. The possible risks and complications of this kind of surgery include:

•    Infection at the surgical site – In general, infections at the surgical site are rare if the procedure is performed correctly by the medical team and if the patient takes a good care of his shoulder after the surgery. People suffering from diabetes, chronic liver diseases, rheumatoid arthritis, etc., have an increased risk of an infection following a shoulder replacement surgery.

Once an infection is diagnosed, antibiotic treatment is required. In certain cases, when there is a severe infection at the surgical site, even a complete removal of the artificial shoulder joint is required.

•    Blood clots – Patients tend to develop blood clots following a shoulder replacement surgery only if they are inactive after the surgery. These are a dangerous complication, even life – threatening as they can lead to pulmonary embolism. Blood clots as a complication of shoulder replacement surgery are more common in overweight and obese patients.

As well as those who have a history of blood clots in the past, patients suffering from cancer, etc.
•    Nerve injury – is a rare complication of shoulder replacement surgery. If a nerve is injured during a surgery, a numbness and tingling sensation, as well as, difficulties moving the muscles can develop. In general, nerve injuries tend to get better in time, often resolving completely.

•    Lack of motion range – in certain cases even after a surgical replacement of the shoulder joint, patients are not able to move their shoulder far enough. They will not even be able to perform regular daily tasks and lead a normal life. How far you will be able to move your shoulder after the surgery greatly depends on how far you were able to move your shoulder even before the surgery.

Physical therapy is very important in such cases. Helping a patient learn how to use the new shoulder joint again gradually and gaining as much motion range as possible after the surgery.

•    Humerus dislocation – usually occurs in cases when the shoulder is stretched more than it should and too soon after the surgery. For this reason, a patient should not move its elbow past the body and toward the back immediately and a couple of weeks after the surgery. With the help of a physical therapy, a patient is taught how to use his new shoulder again gradually.

•    Humerus fracture – even though it is a rare complication of a shoulder replacement surgery, it can occur during and even after the surgery.

•    Joint instability – occurs if the parts of the joints loosen up after the surgery. It also occurs if the soft tissue of the shoulder joint gets stretched out more than it should too soon after the surgery.