What You Need to Know: Shoulder Replacement

Total Shoulder Replacement Surgery Overview

In total shoulder replacement surgery, doctors will replace the ends of the humerus and the scapula and cap the ends with artificial surfaces that are lined with plastic or metal and plastic. 

Total Shoulder joint components may be held in place with cement. Or they may be made with material that allows new bone to grow into the joint even without the use of cement.  

Your shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The shoulder is termed a ball-and-socket joint: The ball, of your upper arm bone, fits smoothly into a shallow socket in your shoulder blade.  The socket is called the glenoid.  shoulder replacement JOIShoulder Replacement

The muscles and tendons that surround the shoulder provide stability and support.  The surfaces of the bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily. 

A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the shoulder joint. In a healthy shoulder, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost any friction in your shoulder. 

For a somewhat easier to follow visual, watch the following video on the shoulder joint anatomy.

Is Total Shoulder Replacement Surgery for me?

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

1. Arthritis of the shoulder joint: 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: In most cases of severe injury to the head or ball of the arm bone can be damaged so bad it cannot be restored and thus it must be replaced. 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: 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 are required for providing stability in the shoulder joint.Over time, the joint suffers due to lack of stability and the onset of arthritis. A shoulder replacement may be recommended. 

Due to various physical limitations, your doctor may decide that you are a candidate for another form of total shoulder replacement. 

Shoulder hemiarthroplasty: where only the head of the humerus is replaced with a metal ball. 

Reverse TSA: where the metal ball and plastic socket are reversed. This procedure is recommended when the rotator cuff muscles of the shoulder are damaged. The plastic socket is attached to the top of the humerus, and the metal ball is attached to the socket. 

How Can Physical Therapy Help?

Physical therapy can play a big role in ensuring a safe recovery by improving shoulder function and limiting pain following a total shoulder arthroplasty.  

Your physical therapist will work with you prior to and follow your surgery, to help you return to your prior level of function including performing household chores, job duties, and recreational activities.

Before Surgery (Prehab)

The better your shoulder range of motion and strength are before surgery, the faster your recovery will be.   Your physical therapist will instruct you on exercises to build shoulder strength, and improve your shoulder range of motion to keep the shoulder as strong and mobile until the time of surgery.

After Surgery (Inpatient/Home Rehab)

Your physical therapist or doctor will educate you about precautions to take after surgery, such as wearing a sling to perform all activities, and gradually beginning to safely move your arm. After your surgery, you will probably stay in the hospital for 2 to 3 days. Your shoulder will be placed in a sling for however long your doctor recommends you be in it. Your physical therapy will begin within a day or two of your surgery. A hospital or home health physical therapist will visit you to teach you how to perform functional tasks like brushing your teeth, and tell you what movements (such as pushing, pulling, or reaching with the affected arm) you simply cannot perform. Your physical therapist will teach you how to get in and out of bed safely, teach you how to don and doff the shoulder sling and how to get dressed while keeping your shoulder in a safe position. You will also learn how to minimize pain and swelling in the area by applying an ice pack and elevating the upper arm in a safe position.  

Outpatient Physical Therapy

When you are discharged from the hospital or home health the next phase of physical therapy is outpatient physical therapy. The physical therapist 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 is done by your physical therapist) move your shoulder in different directions to allow you to safely begin regaining movement. 

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 the 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 may be done passively or actively.   

If you need to schedule an appointment, call JOI -2000. 

By: Jon Stiffler PTA/ Sport Center Manager

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