What is arthritis of the shoulder?
The shoulder joint is a ball and socket joint. The surfaces of the ball and socket are covered by cartilage. This is a very smooth surface that allows the joint to move easily. Normally the smooth surface of the ball glides on the socket. In arthritis the cartilage layer is worn away exposing the bone beneath. This results in the bone of the ball grinding against the bone on the socket.
What are the symptoms of shoulder arthritis?
Patients with arthritis will experience shoulder pain and stiffness. Often patients describe the pain as a dull, constant ache (similar to a tooth ache). The stiffness in the shoulder makes it difficult to perform daily activities such as bathing, dressing and working. It is often very hard to place the hand behind the back.
What are the treatment options?
There are several possible treatments for shoulder arthritis. Selecting the appropriate treatment depends on the severity of symptoms as well as the needs of the patient. Some of the options are:
- Medications (anti-inflammatory medications, Tylenol)
- Stretching exercises
- Cortisone Injections
- Shoulder replacement surgery
What is our treatment approach?
The first step is to try a period of non-operative treatment. This includes medications to control pain and stretching exercises to improve range of motion and prevent further stiffness. If symptoms do not improve then a cortisone injection might be considered.
If symptoms still continue surgery might be considered to perform a shoulder replacement.
What pain medications do you recommend?
We recommend that patients control their pain using non-prescription strength medications. Anti-inflammatory medications such as Motrin, Ibuprofen, Alleve, etc. are effective. Tylenol may also be used in addition to an anti-inflammatory. It is important that you not exceed recommended dosages.
Importantly, we do not recommend narcotic pain medications for shoulder arthritis. Although they provide temporary pain relief, long term use of narcotics can make the situation worse. If a patient is requiring continued narcotics to control their pain it is probably time to consider a different treatment.
What are the surgical options for shoulder arthritis?
A shoulder arthroplasty is the surgical treatment for shoulder arthritis. This is also called a “shoulder replacement”. This procedure is similar to a knee replacement, or hip replacement, which are common operations performed for arthritis of the knee and hip.
When a total shoulder replacement is performed the rough surfaces of the ball (humeral head) and socket (glenoid) are replaced with a smooth metal ball (humeral head) and plastic socket (glenoid). This operation tends to be extremely succesfull for decreasing pain and also can increase the shoulder’s range of motion. This operation has been performed for over 60 years and has a proven track record of success.
What activities will I be able to do with a total shoulder replacement?
Patients are permitted to do the vast majority of activities with a total shoulder replacement. This includes golf, tennis, horse back riding, etc. What is not allowed is heavy lifting overhead repetitively (greater than 25lbs).
Why can’t I lift heavy weights if I have had a total shoulder replacement?
The weak link of a total shoulder replacement is the glenoid component (plastic socket) which is cemented in place. This socket cannot withstand heavy lifting and could become loose over time, especially if a patient is very active. Therefore, a total shoulder replacement is not recommended for young patients (less than 40 years old) or patient who commonly perform heavy lifting or manual labor. In general, patients should not lift more than 25 pounds with an arm that has had a total shoulder replacement.
If a patient needs to do heavy lifting a different form of shoulder replacement called a “ream & run” is recommended. This doesn’t involve using a plastic socket.
What is the recovery process following surgery?
After surgery, most patients will spend two days in the hospital before being discharged to their home. You will be given a prescription of pain medications. Most patients only need to take pain medicine for a few weeks and many notice that their shoulder is very comfortable within a few days after surgery.
For the first six weeks after surgery we want your shoulder to rest and heal. You will be wearing a sling at all times except when doing stretching exercises and bathing. During this time you will be doing stretches several times per day to prevent stiffness. You will be able to use your hand for activities such as writing and eating.
After six weeks you will stop wearing the sling. At this time you will begin lifting the arm in the air and trying to reach overhead. It will take several weeks before you regain the strength to do this easily and the physical therapist will help you regain your strength.
Most patients are able to do most daily activities by three to four months. You will continue to make improvements in strength for up to a year.
Physical therapy protocol for after a shoulder arthroplasty
Learn more about reverse shoulder replacements
Learn more about the "Ream & Run" shoulder replacement