Total Shoulder Arthroplasty
Arthritis of the shoulder joint results from loss of articular (tread) cartilage from the cup or glenoid and the ball or humeral head. The degeneration and bone on bone rubbing of the joint surfaces oftentimes produce significant pain and dysfunction. Arthritic spurs as well as bone erosion can occur. When shoulder arthritis develops, deep, aching pain along with restriction of motion of the shoulder can occur. Use of the shoulder may exacerbate the pain. Occasionally, shoulder arthritis can be caused from inflammatory conditions such as rheumatoid arthritis. As the disease progresses, pain may be present even at rest, or at night. On physical examination, significant restriction of motion as well as grating or grinding sensations may be present with movement of the shoulder. Generalized weakness of the shoulder may also occur and is often related to lack of use. The extent of the arthritis is able to be identified on plain x-ray films. Large spurs, or ridges of bone, in addition to loss of joint space are identified. Possible loss of bone identified on x-rays may require further imaging including an MRI or CAT scan. Conservative measures include ice, nonsteroidal anti-inflammatories, gentle range of motion and strengthening exercises. Physical therapy and cortisone injections may be of benefit as well. When conservative treatment is no longer effective, replacing the worn and arthritic surfaces may provide the best option for pain relief and improvement of function. A high-density plastic component is used to create a new surface for the cup. In most instances, the component is cemented into position after bone preparation. The ball or humeral head is generally replaced with a metallic component, which may or may not be cemented into place in the upper arm bone. Pain relief is good to excellent and oftentimes range of motion is significantly improved. Physical therapy helps to restore range of motion and strength.