Total Shoulder Replacement

By Tim Burkhart, PT

Do I Need A Total Shoulder Replacement?

First of all let us explain the terminology related to this procedure.  A total shoulder procedure is where the arthritic portions of the shoulder joint are replaced.  The word arthroplasty basically means a surgical procedure. This can also be called a total shoulder replacement.

The following are three of the most common reason for patients to have total shoulder arthroplasty:

1. Arthritis of the shoulder joint: This is most often occurring in patients over the age of 50. This degenerative condition causes stiffness and pain in the shoulder joint as protective cartilage wears down over the years. Osteoarthritis is one of the most common reasons that patients have this procedure done.

2. Fractures: Severe injury to the head or ball of the arm bone. Depending on the health of the socket portion of the shoulder joint (clavicle), a doctor may recommend a partial or total shoulder replacement to replace the broken bone to help stabilize the joint and restore function to the arm.

3. Rotator Cuff Tear: A rotator cuff tear happens when a patient sustains an injury to one of the four muscles that wrap around the upper portion of the arm bone. These muscles provide stability in the shoulder joint. Over time, the joint suffers due to a lack of stability and the onset of arthritis.  The best treatment may be a shoulder replacement.

What is a Total Shoulder Arthroplasty?

The quick answer is that a total shoulder arthroplasty is a shoulder joint replacement.  A total shoulder replacement is a surgical procedure to alleviate pain, improve range of motion and improve overall functional mobility. The procedure replaces the natural joint because of pain due to degenerative changes and/or severe rotator cuff dysfunction.  It is successful in treating severe pain and stiffness in the shoulder. There are two types of total shoulder replacement procedures:

1. Traditional Shoulder Replacement
2. Reverse Total Shoulder Replacement

What is Traditional Total Shoulder Arthroplasty?

This procedure decreases pain and dysfunction associated with severe arthritic changes in the shoulder.  In this procedure, the entire shoulder joint is replaced by a metal and plastic prosthetic device.  The ball (humeral head) is replaced with a metal component, while the socket is replaced with a plastic component.  The prosthetic components are designed to mimic the natural joint as closely as possible.

What is a Reverse Total Shoulder Arthroplasty?

The reverse shoulder procedure is for patients who have massive rotator cuff damage.  In a reverse replacement, the socket is placed at the end of the arm, and the ball is placed where the socket would be on the shoulder blade.  When there is significant rotator cuff dysfunction, the orientation of the replacement components must be reversed. This optimizes the potential range of motion, functional mobility, and decreasing pain due to associated arthritic changes in the joint.

If you would like to learn more about the Anatomy of the Shoulder, this VIDEO can help.

How Long is Recovery After Total Shoulder Replacement Surgery?

In the early phase of recovery, the movement of the shoulder is limited. This allows healing of the muscle that was cut during the surgery and allows ample time for the cement used to adhere the components to the bones.  Following the reverse shoulder, motion is encouraged early, and the overall recovery time is typically faster than the traditional procedure.  With both procedures, the patient will participate in 8-12 weeks of formal physical therapy, followed by approximately 6 months of a home exercise program.  Overall recovery concerning pain, range of motion, and functional mobility can take up to 6-12 months. You must follow your doctor’s recommendations to help with your recovery.

What is the Success Rate And Risk with Total Shoulder Replacement Surgery?

Pain reduction, strength, and range of motion are approximately 90% effective in patients ranging from 60 to 80. Many people end up with a functional shoulder and can return to daily activities without pain. Some patients can even return to low-impact sports. Shoulder replacements can last at least 10 to 20 years.  A total shoulder replacement can be an effective method for treating shoulders to restore comfort and function.

Complications with any joint replacement surgery may include:

• Dislocation
• Infection
• Loosening of the replacement components
• Reactions to the metal implant
• Defects in the components themselves

Following these procedures, the surgeon will also monitor the patient for rare but possible vascular or neurological issues that could arise over time.

What Can I Not Do After A Total Shoulder Arthroplasty?

After a total shoulder replacement, you should not do any lifting, reaching, pushing, or pulling during the first 6 weeks after your surgery. Do not reach behind your back with the operative shoulder. Proper use of a shoulder sling is vital. Watch this VIDEO to learn how to use a shoulder sling at home properly. The proper use of a sling will help keep your shoulder stabilized and minimize pain. Once you have recovered from surgery, you should not do any overhead sports, weightlifting, or heavy work duties. Don’t forget to stay positive and appreciate the awesome things your body can do.

Physical Therapy After a Total Shoulder Arthroplasty

Early motion after surgery is critical for achieving optimal shoulder function. JOI offers 12 rehab locations throughout Northeast Florida. Our physical therapists use the latest technology and techniques to get you on the road to recovery.  JOI’s physical therapists will teach you exercises that may include:

Range-of-Motion Exercises: It is important to not move your shoulder suddenly or with any force for the first 2 to 6 weeks following surgery to allow proper healing. Your physical therapist will passively (a movement that your physical therapist does) move your shoulder in different directions to allow you to begin regaining movement safely.

Your physical therapist will also teach you gentle exercises to perform at home. You will also learn range-of-motion exercises for the elbow and hand, so these joints do not get stiff.

Strengthening Exercises: As mobility returns within a few weeks or months, your physical therapist will instruct you through a safe and effective shoulder strengthening program. You may use resistive bands and free weights/machines to perform gentle strengthening exercises.

Functional Training: Your physical therapist will help you regain everyday shoulder movements, such as reaching into a cupboard, reaching behind your body to tuck in your shirt, or reaching across your body to fasten a seat belt. These functional movements can be either passive or active or both.

What are Codman’s Exercises or Pendulum Exercises?

The quick answer is they are gentle mobility exercises to get the shoulder to move and relax. They can also decrease pain in the shoulder. Pendulum exercises are a common exercise after shoulder surgery.  The goal is to get the shoulder joint moving and help manage pain.

Lean forward and allow the painful arm/shoulder to hang. Then gentle rock your hips and body side to side and front to back and allow the arm to sway with the body’s momentum. Continue 2 to 3 minutes. Be gentle.

Even if you do not experience pain after the exercise, it is important to ice your shoulder. Just 10-15 minutes after will help. You mustn’t exercise if you are experiencing pain.

If you have recently had a shoulder surgery please watch this helpful video: Dressing the Upper Body After an Injury or Surgery

Total Shoulder Arthroplasty in Jacksonville

The Jacksonville Orthopedic Institute is the leader in treating shoulder issues.  We offer conservative treatment options for advanced shoulder joint replacement surgery. JOI is Northeast Florida’s Leader in Orthopedic Care and Joint Replacement Surgery. If you have shoulder pain, get on the Road to Recovery with JOI.

To schedule physical therapy at one of the 12 JOI Rehab Centers, please call 904-858-7045  or read Direct Access to Physical Therapy.

Finally, to see a JOI Orthopedic Shoulder Specialist, call 904-JOI-2000, schedule online, or click the link below.