Guide to Shoulders

This page provides a brief introduction to shoulder replacement. It can help you make a list of questions to ask your doctor, but it is not meant to provide complete information. Check with your surgeon''s office about more comprehensive resources and patient education materials.

Teach me a little about the shoulder.
The shoulder is a ball and socket joint. The ball portion of the joint consists of the rounded head of the upper arm bone (humerus), and the socket portion is made up of a depression (glenoid) in the shoulder blade. The humeral head (ball) fits into the glenoid (socket) creating the joint that allows you to move your shoulder. The joint is surrounded and lined by cartilage, muscles, and tendons that provide support, stability, and ease of movement.

The shoulder allows for the rotation of the arm in all directions. The range of motion is dependent on the proper articulation of the humeral head upon the glenoid (shoulder socket).

How do I prepare for shoulder replacement surgery?
If you and your surgeon decide that total shoulder replacement is right for you, a date will be scheduled for your surgery. Several things may be necessary to prepare for surgery. For example, your surgeon might ask you to have a physical examination by your primary care physician. This will ensure that other health problems you may have, such as diabetes or high blood pressure, will be treated before surgery. Your doctor, or a staff ember, will advise you about the things you can do to prepare for your hospital stay, and your rehabilitation after surgery.

What happens during shoulder replacement surgery?
One the day of surgery, an intravenous tube will be inserted into your arm to administer necessary medications and fluid during surgery. You will then be taken to the operating room and given anesthesia. After the anesthesia takes effect, your shoulder will be scrubbed and sterilized with a special solution that removes bacteria from your skin.

The procedure is performed through an incision over the shoulder that will expose the joint. Special, precision guides and instruments will be used to cut the humeral head (ball) and prepare the bone to accept the implant. The new metal ball and stem are then inserted. If the socket is to be resurfaced, its damaged surface is smoothed and the new plastic surface is inserted. The ball and socket are then joined. When the surgeon is satisfied with the fit and function, the incision will be closed and covered with dressings. A special drain may be inserted into the wound to drain the fluids that naturally develop at the surgical site. The surgery usually takes one to three hours, although this depends on the severity of the arthritis in your shoulder.

A sterile bandage will be placed over the wound, and you will be sent to the recovery room where you will be carefully monitored. As the anesthesia wears off you will slowly regain consciousness. A nurse will be with you, and may encourage you to cough or breathe deeply to help clear our lungs. Your arm will be in a sling or brace, and it may be wrapped in an ice pack to help control pain and swelling. You will also be given pain medication. When you are fully conscious, you will be taken back to your hospital room.

What can I expect after surgery?
When you are back in your hospital room, you will begin a gentle rehabilitation program to help relax the muscles around your new shoulder. On the day of surgery you may be encouraged to get out of bed and take a few steps. You will continue to receive pain medication as needed, and your bandage will be removed about two days after surgery.

Depending on your specific situation, you will probably remain in the hospital from one to three days. Your shoulder area may be warm and tender for several weeks. Before you are dismissed from the hospital, your physical therapist will show you how to perform the rehabilitation exercises that are important for your recover.

How soon can I return to normal activities after surgery?
Successful joint replacement surgery may relieve your pain and stiffness, and may allow you to resume some of your normal daily activities as instructed by your doctor. But even after you have fully recovered from your surgery, you may still have some restrictions. Normal daily activities for shoulder replacement patients do not include contact sports "jamming" activities such as hammering, repetitive heavy lifting, or activities that put excessive strain on your shoulder. Although your artificial joint can be replaced, a second implant is seldom as successful as the first.

How long will a shoulder replacement last?
Longevity of the prosthetic shoulder varies from patient to patient. It depends on many factors, such as a patient''s physical condition and activity level, as well as the accuracy of implant placement during surgery. It is useful to keep in mind that prosthetic joints are not as strong or durable as a natural, healthy joint, and there is no guarantee that a prosthetic joint will last the rest of a patient''s life.

Today, total shoulder replacement is becoming a common and predictable procedure. Many patients enjoy relief from pain and improved function, compared to their status before surgery. As a result, some patients may have unrealistic expectations about what the prosthetic shoulder can do and how much activity it can withstand. As with any mechanical joint, the ball and socket components move against each other. Natural fluid in the joint space, called synovial fluid, helps to lubricate the implants just as it lubricates the bones and cartilage in a natural joint. Still, the prosthetic components do wear as they roll and slide against each other during movement. As with car tires or brake pads, the rate of wear depends partly on how the shoulder joint is used. Activities that place a lot of stress on the joint implants, as may be the case with more active patients, may reduce the service life of the prosthesis. Implant loosening and wear on the plastic portions of the implant can lead to the necessity for revision surgery to replace the worn components, or all of the components. Your doctor will be in the best position to discuss these issues with you, taking into account your particular clinical circumstances, the type of implants used, and your post-surgical lifestyle.

Talk with your doctor about the following points, and how they might affect the longevity and success of your shoulder replacement:

• Avoiding repetitive heavy lifting

• Avoiding "jamming" activities such as hammering

• Staying healthy and active

• Avoiding "impact loading" sports such as boxing

• Consulting your surgeon before beginning any new sport or activity, to discuss what type and intensity of sport or activity is appropriate for you

• Thinking before you move

• Not lifting or pushing heavy objects