As a shoulder specialist I do treat a fair amount of patients with shoulder arthritis.
And there are varying degrees of shoulder arthritis, from very mild to what we call
severe – when it's bone on bone arthritis, which most people have heard of that term
before.
When we're considering the treatment options for shoulder arthritis, first and foremost
the decision is based on how much does the pain impact a patient's quality of life?
The symptoms that people have when they have shoulder arthritis tend to be first pain,
especially pain at night that prevents them from sleeping, but also pain with use and
pain with activities.
Many patients with more advanced arthritis lose their range of motion and their shoulders
become quite stiff, and it's hard for them to reach as high as they once did and simple
activities such as fastening one's bra, putting cups away in the cupboard, washing your hair
can become quite difficult.
Typically it's at this point when the pain and the lack of function are impacting drastically
a patient's life is when they come to see me as a shoulder specialist.
When we first start treating shoulder arthritis there are a variety of conservative treatment
options and this ranges from rest, many patients try moist heat, a variety of anti-inflammatories
can be used.
We occasionally do cortisone injections.
The relief is temporary from cortisone but it can provide great relief and can certainly
put off the need for more invasive surgery.
The definitive treatment for should arthritis is a shoulder replacement.
Now certainly the thought of a shoulder replacement is very daunting for many patients.
It seems quite overwhelming to consider that.
However, it is quite a successful surgery and the outcomes are so good and so predictable,
most patients when they finally decide to have a shoulder replacement typically come
back and say, wow why didn't I do this earlier?
But for every patient it's an individual decision when you are ready for a shoulder replacement.
Of course your x-rays and your physical exam have to correlate with one who would be ready
for a shoulder replacement, but when all the pieces add up patients do decide to go ahead
with the shoulder replacement surgery.
Again, shoulder replacement surgery is one of the most reproducible surgeries that we
do as shoulder specialists.
It's very rewarding because the affects are almost immediate.
The goal of shoulder replacement surgery is not only to relieve your pain but to restore
your quality of life and restore your range of motion.
We traditionally see most patients come in at their first postoperative visit, which
is about two weeks out from surgery and can already say that arthritis pain is gone.
So although they have surgical pain, they can tell the arthritis pain is gone and they
are already starting to feel better.
It is typically a two-hour surgery.
Typically it's a two-night stay in the hospital.
Shoulder surgery is quite painful and we need to prepare our patients that after shoulder
replacement surgery the first few days can be pretty rough.
However, we have a wonderful team at our hospital.
We have a shoulder team.
We have wonderful anesthesiologists that provide the latest techniques in anesthesia for shoulder
surgery.
We do something called a nerve block, it's an interscalene nerve block and essentially
our anesthesiologists numb up the nerve to your entire arm and they actually put a little
catheter in your neck.
It's about in this area here and while you're in the hospital that little catheter bathes
the nerves in your arm with a numbing solution and that really helps take the edge off of
your pain.
We have a wonderful team of physical therapists and shoulder physical therapists here at Ohio
State.
And we use that protocol for rehabbing our patients after surgery.
We have many patients that come from far away and we absolutely understand that is best
to have your therapy close to home, but because we have such a detailed protocol, we can give
our protocol to your therapist and they know exactly how we like to rehab you.
Of course we're always open to phone calls so any therapist that has a question can contact
our therapists at any time.
Your therapy does start in the hospital and we continue therapy for about three months.
Typically patients go to therapy about two times a week for three months and some patients
go for a longer period of time if they so desire.
You do wear a sling for six weeks after shoulder surgery and that's primarily for your own
protection.
All shoulder replacement surgery does require that we make an incision or we cut your front
rotator cuff tendon.
We have to do that in order to place the replacement.
We do fix that rotator cuff tendon at the end of surgery.
However, it does take three months for that to heal.
So because of that we don't allow you to go behind your back with your hand and you cannot
push yourself up from a seated position with your operative side.
So that you don't forget, the sling is really your reminder and that's the main reason for
the sling.
Everyone comes out of the sling at the six-week mark and you're allowed to progressively use
your hand for activities around the house, but you're not allowed to lift anymore than
your coffee mug for three months.
At the three-month mark most people are ready for a home physical therapy protocol.
Your front rotator cuff tendon is healed and as long as everything checks out on your three-month
visit to me in the office, we let you slowly go back to your normal activities.
A lot of patients do ask, what can I do after shoulder replacement surgery?
And the goal of shoulder replacement surgery is to let you go back to the things that you
like to do.
We have many patients that their goal is to golf, or to play tennis or to swim and certainly
we allow that.
Now we do have some weight restrictions after shoulder replacement surgery.
We want the shoulder replacement to last so we really don't encourage contact sports,
we don't want heavy construction work or heavy manual labor.