By Frederick Song, MD
When you have shoulder pain, raising your arm for simple tasks like brushing your hair or putting groceries away can be agonizing.
Often, the pain can be treated with conservative treatments such as physical therapy, cortisone injections and rest.
However, when it starts to impede your ability to perform everyday activities and affects your quality of life including the inability to sleep through the night, shoulder replacement surgery may be necessary.
At Penn Medicine Princeton Medical Center (PMC), board certified orthopedic specialists offer a wide range of effective treatment options for shoulder problems, including minimally invasive, same day shoulder replacement surgery.
Osteoarthritis, Rotator Cuff Tears
Each year, millions of people visit the doctor for shoulder pain, according to the American Academy of Orthopaedic Surgeons (AAOS). In fact, shoulder pain affects between 5 and 21% of the adult population, according to AAOS.
While the pain can be caused by a variety of factors, two of the most common culprits are osteoarthritis and rotator cuff tears.
Shoulder osteoarthritis (also known as glenohumeral osteoarthritis) is the loss of the cartilage that caps the humeral head and the glenoid (socket). As the cartilage degenerates, the lining of the joint called the capsule becomes inflamed. In more advanced cases this results in pain and stiffness of the shoulder. When the majority or all the cartilage has worn away the underlying bones rub together causing significant pain, stiffness, and dysfunction.
Osteoarthritis typically affects people over age 50 and generally worsens with age. In fact, age is the number one risk factor in osteoarthritis of the shoulder. In addition, there may be a genetic component to osteoarthritis inherited from your parents, and prior injuries to the affected shoulder can also increase the risk of developing the disease.
The rotator cuff is comprised of four tendons that help to stabilize and move the shoulder. A rotator cuff tear occurs when one of the tendons tears off the bone traumatically or by degeneration over time. A rotator cuff tear may weaken your shoulder and cause pain. If left untreated, chronic rotator cuff tears can become larger and may not be able to be repaired using traditional arthroscopic techniques. In this situation, reverse shoulder replacement has been a game changing technological advancement that has helped address this disorder.
As with osteoarthritis, your risk for rotator cuff tears increases with age. Additionally, athletes, such as baseball pitchers and tennis players, along with people who perform overhead work may be at greater risk for rotator cuff tears.
When to See a Doctor
With both osteoarthritis and rotator cuff tears, pain is the main symptom. This pain may:
- Be worse at night, making sleeping difficult.
- Be aggravated by activity.
- Occur when lifting and lowering your arm or with specific movements.
Other symptoms may include limited range of motion and a grinding, clicking or snapping sound (crepitis) when you move your shoulder.
If you experience shoulder pain that does not go away, it is time to see your doctor. They will likely refer you to an orthopedic specialist for further evaluation.
Osteoarthritis and rotator cuff tears can typically be diagnosed with a physical exam in the office along with imaging tests, such as X-rays and an MRI.
Shoulder Replacement Surgery
In treating shoulder pain associated with osteoarthritis and non-repairable rotator cuff tears, orthopedists usually recommend conservative measures first. If conservative treatment is not enough to bring relief or the pain returns, shoulder replacement surgery may be recommended.
According to the AAOS, shoulder replacement surgery is increasingly common with more than 100,000 people in the U.S. undergoing the procedure each year.
Additionally, the AAOS notes that shoulder replacement surgery is becoming as successful as hip and knee replacement surgery at reducing pain and enabling patients to resume everyday activities.
There are two different types of shoulder replacement surgery:
- Anatomic shoulder replacement. The damaged ball and socket of the shoulder joint are replaced with artificial components. This is performed when osteoarthritis is the cause of shoulder pain.
- Reverse shoulder replacement is reserved for patients with a non-repairable rotator cuff tear or in cases with severe bony deformity from longstanding osteoarthritis. The anatomy of the shoulder is reversed by attaching a prosthetic ball where the socket would be and vice versa. This is a more constrained prosthesis that helps to reestablish the fulcrum that is lost in large, non-repairable rotator cuff tears.
Orthopaedic surgeons at PMC perform shoulder replacement surgery using minimally invasive techniques that require smaller incisions (3 inches) and typically result in a quicker recovery time than traditional surgery. Moreover, most patients are able to return home on the same day of their surgery, which generally takes about an hour.
Patients typically require a sling for two to four weeks after surgery. Most patients begin physical therapy two to four weeks after surgery and continue two to three times a week for between two and four months. Once recovered, patients can resume normal activities and participate in non-contact sports, such as pickleball, golf, tennis, and swimming.
If unrelenting shoulder pain is keeping you from leading an active life or affecting your ability to sleep, get dressed on your own or perform other routine tasks, talk with your doctor or consult an orthopaedic specialist.
Shoulder replacement surgery can help return you to a life free of pain and full of the activities you love.
To find an orthopaedic physician affiliated with Penn Medicine Princeton Health, call 1 (888) 742-7496 or visit www.princetonhcs.org/directory.
Frederick Song, MD, is a board certified, orthopaedic surgeon on the medical staff of Penn Medicine Princeton Health.
