Revision Shoulder Surgery in Bath

Shoulder anatomy

The shoulder joint is similar to a ball-and-socket joint that is comprised of three main bones: the collarbone (clavicle), the shoulder blade (scapula) and the upper arm bone (humerus), which extends from the shoulder blade to the elbow.

The upper end of the humerus where it rotates is a smooth, rounded head (ball) that fits into the glenoid cavity (socket) of the shoulder blade. Because the ball is larger than the socket, it is more flexible, but has less inherent stability. Muscles, tendons and connective tissue protect the shoulder joint and hold the various parts together.

Because the shoulder joint is stabilized by muscles and tendons, rather than by bone, the shoulder has great flexibility. This gives the shoulder joint a wide range of motion, enabling movements such as lifting, pushing and pulling. However, this great degree of motion has a trade-off; the stability of the shoulder is dependent upon the surrounding soft tissue and can result in a larger number of problems not faced by other joints supported by bony structures. A healthy shoulder can be damaged by disease or injury, resulting in severe pain, pseudoparalysis (false paralysis) and muscle weakness.

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Shoulder Conditions

Osteoarthritis

Osteoarthritis (degenerative arthritis), the most common form of arthritis, affects nearly 21 million people in the United States. It is a condition that causes wear and tear to your joint cartilage and develops after years of constant motion and pressure on the joints. As the cartilage continues to wear, the joint becomes inflamed and can result in unbearable pain and decreased range of motion. If non-surgical treatment options such as medication, physical therapy or lifestyle changes fail to provide relief, your surgeon may recommend a surgical treatment, including shoulder replacement.

Inflammatory (Rheumatoid) Arthritis

Inflammatory arthritis is a chronic joint disease that can attack any or all joints in the body. It can strike at any age and affects more women than men. In the shoulder, inflammatory arthritis causes the synovium to thicken and form a tissue growth (pannus) that clings to the protective cartilage and releases chemicals that attack and destroy it. The joint may become
red and swollen, and pain may radiate into the neck and arm. Over time, the joint may become stiff and the muscles may weaken from lack of use. The bone also may be destroyed.

Rotator Cuff Tear

Most people with a small cuff tear can be treated arthroscopically. Surgery for rotator cuff tears usually occurs when a patient has a combination of shoulder arthritis and a massive irreparable rotator cuff tear. The rotator cuff is a group of muscles/tendons (supraspinatus,
infraspinatus, teres minor and subscapularis) that surround the shoulder in order to keep the shoulder centered while performing shoulder-related tasks such as elevating and rotating the upper arm.

Avascular Necrosis

Avascular necrosis is a disease in which there is a temporary or permanentloss of blood supply to the bone. A number of conditions, including longterm use of steroids or alcohol, a traumatic injury, rheumatoid arthritis or unhealed fractures can cause the blood supply to the bone to be cut off. As the bone dies, it collapses. Although avascular necrosis can happen in any bone, it usually affects the ends of long bones such as the humerus.
When this happens, the shoulder becomes painful and movement becomes limited.

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What are my treatment options?

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Total shoulder replacement

The shoulder is the third most frequently replaced joint after the hip and knee. Lack of range of motion and pain that affect day-to-day activities are the main reasons patients consider this operative treatment.

Primary vs. Reverse Shoulder

A primary shoulder replacement mimics the natural anatomy of the shoulder: a plastic “cup” is fitted into the shoulder socket (glenoid), and a metal “ball” is attached to the top of the upper arm bone (humerus). In a reverse total shoulder replacement, the socket and metal ball are switched.The metal ball is fixed to the socket and the plastic cup is fixed to the upper end of the humerus. A reverse total shoulder replacement typically works better for people with cuff tear arthropathy because it relies on different muscles to move the arm.

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Surgery

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Summary

This information is not intended to replace the experience and counsel of your orthopaedic surgeon. Surgery is one of the most important decisions you will make. Shoulder replacement has allowed millions of people to live with less pain and to return to more active lifestyles.

Your surgeon will help you decide if it’s the right choice for you. With any surgery, there are potential risks, and results will vary depending on the patient. Joint replacement surgery is not for everyone. Check with your physician to determine if you are a candidate for joint replacement surgery. Your physician will consider the risks and benefits associated with this procedure, as well as individual factors such as the cause of your condition, and your age, height, weight and activity level.

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