Shoulder Anatomy

The shoulder is a highly movable body joint that allows various movements of the arm. It is a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade), which is called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

What is Arthritis?

When the cartilage is damaged, the two bones rub against each other causing pain, swelling and stiffness of the joint. This condition is called arthritis. There are many types of arthritis. Osteoarthritis (wear-and-tear brought about by old age) and rheumatoid arthritis (autoimmune disease) are two forms of arthritis.

What is Shoulder Joint Replacement?

Total shoulder replacement surgery is performed to relieve these symptoms. In this surgery, the damaged articulating parts of the shoulder joint are removed and replaced with artificial prostheses. Replacement of both the humeral head and the socket is called a total shoulder replacement.

What are the Indications for Shoulder Joint Replacement?

Total shoulder joint replacement is a surgery indicated for conditions such as osteoarthritis or rheumatoid arthritis when medication, injections, physical therapy, and activity changes do not help relieve pain. Your doctor recommends surgery when you have the following symptoms:

Severe shoulder pain that restricts daily activities
Moderate to severe pain during rest
Weakness and/or loss of motion

Preparation for Shoulder Joint Replacement

To decide whether total shoulder replacement is a good option for you, your surgeon will evaluate your condition thoroughly.
Your surgeon reviews your medical history and performs a physical examination of your shoulder to assess the extent of mobility and pain. Imaging tests such as X-ray or MRI (magnetic resonance imaging) are ordered.

Shoulder Joint Replacement Procedure

The surgery is performed under regional or general anesthesia. An incision is made over the affected shoulder and the underlying muscles are separated to expose the shoulder joint. The surgery may be performed as an open surgery, where a large incision is made, or minimally invasive, where small incisions are made to insert an arthroscope (a thin tube with a camera and light source) and surgical tools.

The upper arm bone (humerus) is separated from the glenoid socket of the shoulder bone. The arthritic or damaged humeral head is cut and the humerus bone is hollowed out and filled with cement. A metal ball with a stem is gently press-fit into the humerus.

Next, the arthritic part of the socket is prepared. The plastic glenoid component is fixed in the shoulder bone.
After the artificial components are implanted, the joint capsule is stitched, and the wound is closed.

Postoperative Care for Shoulder Joint Replacement

After the surgery, medications and antibiotics are prescribed to control pain and prevent infection. Your arm may be secured in a sling or cast. The rehabilitation program includes physical therapy, which is started soon after the surgery and is very important to strengthen and provide mobility to the shoulder. You may be able to perform gentle daily activities two to six weeks after surgery.

Risks and Complications of Shoulder Joint Replacement

As with any major surgery, there may be potential risks involved:

Anesthetic complications such as nausea, dizziness, and vomiting
Infection of the wound
Dislocation, requiring repeat surgery
Damage to blood vessels, nerves or muscles
Failure to relieve pain
Pulmonary embolism
Wear and tear of the prosthesis

Reverse Shoulder Replacement

What is Reverse Shoulder Replacement?

Conventional surgical methods such as total shoulder joint replacement have been shown to be significantly ineffective in the treatment of rotator cuff arthropathy. Reverse total shoulder replacement is an advanced surgical technique specifically designed for rotator cuff tear arthropathy, a condition where you suffer from both shoulder arthritis and a rotator cuff tear.

Differences between Conventional and Reverse Shoulder Replacement

Conventional shoulder replacement surgery involves replacing the ball of the humerus with a metal ball and the glenoid cavity of the shoulder blade (scapula) with a plastic socket. If this surgery is used to treat rotator cuff arthropathy, it may result in loosening of the implants due to the torn rotator cuff. Therefore, a specifically designed surgery was developed called reverse total shoulder replacement to be employed in such cases.

In reverse total shoulder replacement, the placement of the artificial components is essentially reversed. In other words, the humeral ball is placed in the glenoid cavity of the shoulder blade (scapula) and the plastic socket is placed on top of the arm bone. This design makes efficient use of the deltoid muscle, the large shoulder muscle, to compensate for the torn rotator cuff.

Ideal candidates for Reverse Shoulder Replacement

Reverse total shoulder replacement may be recommended for the following conditions:

Completely torn rotator cuff that is difficult to repair
Presence of rotator cuff tear arthropathy
Previous unsuccessful shoulder replacement
Severe shoulder pain and difficulty in performing overhead activities
Continued pain despite other treatments such as rest, medications, cortisone injections and physical therapy

Reverse Shoulder Replacement Procedure

Reverse total shoulder replacement surgery is performed under general anesthesia.

Your surgeon makes an incision over the affected shoulder to expose the joint.
The humerus is separated from the glenoid socket of the scapula.
The arthritic parts of the humeral head and the socket are removed and prepared for insertion of the artificial components.
The artificial components include the metal ball that is screwed into the shoulder socket and the plastic cup that is cemented into the upper arm bone.
The artificial components are fixed in place.
The joint capsule is stitched together, the tissues approximated and the wound is closed with sutures.

Postoperative care for Reverse Shoulder Replacement

You can get out of bed on the same day of the surgery but will usually have to stay in the hospital for 1-2 days. General postoperative instructions include:

Take all prescribed medications as instructed.
Undergo a gentle range of motion exercises to increase your shoulder mobility.
Physical therapy will be recommended to strengthen the shoulder and improve flexibility.
Avoid overhead activities for at least 6 weeks.
Don’t push yourself up out of a chair or bed using your shoulder muscles.
Avoid lifting heavy objects.

Risks and Complications of Reverse Shoulder Replacement

The possible risks and complications associated with reverse total shoulder replacement surgery include:

Infection
Dislocation or instability of the implanted joint
Fracture of the humerus or scapula
Damage to nerves or blood vessels
Blood clots (deep vein thrombosis)
Wound irritation
Arm length discrepancies
Wearing out of the components

Shoulder Hydrodilatation

Shoulder Anatomy

The shoulder joint is a ball and socket joint formed by the union of the head of the upper arm bone (humerus) and the shoulder socket (glenoid). A rotator cuff is a group of four tendons that join the head of the humerus to the deeper shoulder muscles to provide stability and mobility to the shoulder joint.

Shoulder Anatomy

The shoulder is a ball and socket joint. The head of the humerus fits into the glenoid cavity of the scapula (shoulder blade). Connective tissue called the shoulder capsule surrounds the shoulder joint, holding the bones in place. This is lubricated by synovial fluid. All these tissues help in stabilizing the joint and allowing the smooth movement of the shoulder.

Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, is a condition characterized by pain and loss of motion in the shoulder joint. Frozen shoulder is caused by inflammation of the shoulder capsule. The shoulder capsule becomes thick, tight, and the stiff bands of tissue called adhesions may develop.

What is Shoulder Hydrodilatation?

Hydrodilatation is one of the latest techniques for the treatment of frozen shoulder. It is performed to decrease the pain and improve the mobility of the shoulder joint.

Preparing for Shoulder Hydrodilatation

Before shoulder hydrodilatation, you should inform your doctor of any of the following conditions:

If you have diabetes
If you have any allergies, especially to contrast material or any medications
If you are on any blood-thinning drugs especially warfarin
If you are feeling unwell
If you are pregnant or suspect pregnancy

Shoulder Hydrodilatation Procedure

You will be placed on an X-ray table and the radiologist, assisted by a nurse or a radiographer, will perform the procedure.
Your skin around the shoulder is sterilized with an antiseptic solution.
A fine needle is then inserted into the shoulder joint under X-ray guidance.
A small amount of contrast medium is injected through the needle to confirm proper positioning of the needle.
Once the position of the needle has been confirmed, a mixture of local anesthetic and steroid is injected into the joint through the needle.
A small amount of sterile saline will also be injected through the needle to distend the joint capsule.
At this instance, you may have a feeling of tightness or heaviness and slight discomfort in your shoulder.
After all the fluid has been injected, the needle is removed, and you will be advised to rest for a few minutes on the table.

Post-operative Care for Shoulder Hydrodilatation

You may need to have a companion drive you home after the procedure. Gentle movements of the shoulder can be performed but avoid heavy lifting and intense activity of the shoulder for the subsequent 3 days following the procedure. You will also be advised for a follow-up appointment with your physician.

Complications of Shoulder Hydrodilatation

You may develop a small facial or neck rash that can last for 2 to 3 days after the procedure, but this generally resolves by itself. Although rare, you may develop a fever. Contact your doctor immediately if you develop fever or experience increased pain or redness at the injection site.