CONDITIONS TREATED

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Location

The normal action of the upper arm bone (humerus) within the glenoid socket in the shoulder blade (scapula) may be lost or impaired, typically because of diminished cartilage joint space, the bone is flattened or irregular, or there are bone spurs, or bone and cartilage fragments are loose within the joint. In severe cases, for example degenerative joint disease (osteoarthritis), bone-on-bone erosion may result from loss of the shoulder joint's natural lining.

Symptoms

In cases of arthritis (which may also be rheumatoid or post-traumatic) patients will feel a deep ache within the shoulder joint that is aggravated by movement. Sometimes these symptoms may also indicate a combination of severe arthritis and a major non-reparable tear of the rotator cuff tendon, or avascular necrosis in which the head of the humerus bone dies due to lack of blood supply. Patients may also experience grinding, locking up and catching sensations in the joint with loss of motion or weakness in the shoulder. Left untreated, the essential stability and support of surrounding muscles and tendons may also deteriorate.

Diagnosis

In older patients, osteoarthritis may develop over time, possibly aggravated by an earlier shoulder injury. Initial physical examination and review of patient history should identify earlier trauma, particularly if the injury has healed imperfectly. Untreated tears in the rotator cuff may also lead to arthritic damage to bone and cartilage. Avascular necrosis may be diagnosed as a result of severe shoulder fracture, deep sea diving, sickle cell disease, heavy alcohol or steroid use.

Treatment

Shoulder joint replacement surgery may be necessary after non-surgical options such as physiotherapy and medication, are ruled out. Conventional total shoulder replacement will depend upon the condition of humeral bone and the rotator cuff tendons, to ensure sound fixing and retention of the new metal and plastic ball and stem that will be implanted and cemented in place. If the natural socket is still normal, the surgeon may only replace the ball.

In patients with a completely torn rotator cuff, cuff tear arthopathy or a failed previous shoulder replacement, a conventional shoulder replacement may still leave them in pain. In these cases, a reverse total shoulder replacement may be recommended. This reverses the positions of the ball and socket, attaching the ball to the shoulder bone and a plastic socket to the upper arm bone, allowing the deltoid muscle to lift the arm instead of the ineffective torn rotator cuff. Most patients should be able to start performing simple activities such as eating, dressing, bathing within 2 weeks of surgery and driving after a further 4 weeks.