Shoulder Anatomy

Read about the Anatomical Structure of the Shoulder – Click here

 

Causes of the shoulder pain

  • Sprain and strain: Sprain and strain are injuries of soft tissues. Injury to the ligaments are called sprains. Ligaments are structures that connect bone to the soft tissue. Strain – stretching or tearing of muscle or tendon.
  • Shoulder Bursitis: Bursitis is the inflammation of bursa. Bursa is the fluid filled sac(bag) located in bones, tendons and muscles around the joint. Bursitis is commonly caused by repetitive minor impact.
  • Shoulder Tendinitis: Inflammation(swelling) of tendon is called tendinitis. Tendon is thick Fiber that connect muscle to bone.shoulder tendinitis is Caused by micro trauma to rotatory cuff tendons.
  • Torn cartilage
  • Brachial plexus injury: Brachial plexus is a group of nerves from spine  conduct signal to shoulder and hand. Injury to brachial plexus causes inability to move your arm and shoulders. Loss of sensation in arms and weakness is experienced by patient
  • Osteoarthritis: Osteoarthritis is the common reason for many patients undergoing total shoulder replacement. The most common form of arthritis, characterized by the wearing and eventual loss of cartilage. Cartilage act as a cushion between the bones of joint. Damage of cartilage causes inflammation of joints, pain, and restricts the range of motion of joints. Usually associated with old age (above 50)
  • Rheumatoid arthritis: It is an autoimmune disease(body’s immune system mistakenly attacking its own tissue). Rheumatoid affects the joint lining tissue, causing pain and inflammation around the joint. Physiotherapy and antirheumatoid medications play an important role in management of the disease.
  • Post traumatic arthritis: Fracture of bone, or tear of surrounding structures, which may later damage the cartilage results in pain and limiting normal mobility of knee joint
  • Rotators cuff tear: Rotator cuff is a group of 4 muscle and their tendons. Rotator cuff provide strength and stability to shoulder. Rotator cuff tear is the most common problem affecting shoulder, characterized by tear of one or more tendons of rotators cuff muscles. Caused by normal wear and tear with age & high impact sports.
  • Rotators cuff tear arthropathy: If rotator cuff tear is not repaired over a period of time, a type of wear and tear arthritis of shoulder develops.
  • Avascular necrosis: Avascular necrosis also known as osteonecrosis is a painful condition characterized by the death of bone due to disruption of blood supply. Disruption of blood supply might be due to Fracture or shoulder dislocation.
  • Fracture: Fractures commonly involves clavicle, and scapula and proximal surface of humerus. Severe Fracture of shoulder offer requires shoulder replacement surgery.
  • Frozen shoulder: Also known as adhesive capsules. Characterized by inflammation and thickening of capsules as a result shoulder joint does not have enough space to function properly. Patient experience severe pain, but stiffness and swelling.
  • Failed shoulder replacement surgery: Shoulder replacement surgery to has excellent success rate, however sometimes failure occurs. Failure may be due to pain, wear, loosening of prosthesis, infection, dislocation of prosthesis, rotators cuff failure, instability or other causes.
  • Referred pain during an Heart attack (Angina)

MANAGEMENT OF SHOULDER PAIN

  • Exercise
  • Medication
    • NSAIDS – non- steroidal anti-inflammatory drugs relieves pain end reduce inflammation of joint
    • Corticosteroids – anti Inflammatory drugs
    • Antirheumatic drugs(DMARDS) – for patients with rheumatic arthritis
    • Injecting corticosteroids directly into joint. It reduces inflammation, pain and improves the range of motion.
    • Injecting hyaluronate directly in the joint
  • Physiotherapy
    • Dislocated shoulder is managed by doctor by fitting humerus back into glenoid cavity. This process is called reduction.
  • Alternative therapy
  • Surgery
    • Total shoulder replacement
      • This procedure involves removing the diseased joint and replacing with artificial metal prosthesis. A metal ball with stem is attached to humerus and plastic socket to glenoid.
    • Stemmed hemiarthroplasty
      • In certain conditions like only humerus is fractured or arthritis involving humerus alone, and cartilage in glenoid is healthy, full shoulder replacement surgery is not advised. Surgeon replaces the humerus ball surface with metal ball stemmed attached to it. Glenoid cavity not replaced.
    • Resurfacing hemiarthroplasty
      • Unlike replacing the ball or head of humerus surface the joint alone is replaced with plastic cup. Indicated in patients with severe rotators cuff damage.
    • Reverse shoulder arthroplasty
      • Conventional procedure of total shoulder replacement is reversed. Instead of metalball attaching to humerus it’s is connected to scapula and plastic cup instead of connecting to glenoid (shallow cavity in scapula) it is connected to humerus. It is Indicated in completely torn rotator cuff, rotator cuff tear arthropathy and failed shoulder replacement.

Total shoulder replacement

The damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis. The treatment options are either replacement of just the head of the humerus bone (ball), or replacement of both the ball and the socket (glenoid)

Objective:

The main objective of total shoulder replacement is to relieve pain and to restore the normal shoulder movement.

Indication:

When all the conventional methods failed to relieve pain and patient unable to perform normal daily activities.

 

The following conditions will need a total shoulder replacement

  • Rotator cuff tear arthropathy
  • Avascular necrosis
  • Failed previous shoulder replacement prosthesis
  • Campound fractures
  • Osteoarthritis arthritis
  • Rheumatoid arthritis

Shoulder replacement surgery – how it is Performed?

Before surgery the doctor will perform a complete physical examination, blood test and other investigations to make sure the patient is medically fit for surgery.

Just Minutes before the surgery either general anesthesia or Local anesthesia is administered to the patient by anesthetist. patient’s vitals are monitored continuously by the anesthetist till the surgery is complete.

Incision is made in the front surface of the shoulder. Shoulder joint is completely exposed. Humerus head is dislocated from glenoid (shallow cavity of scapula).

Humerus is completely examined, and diseased portion is removed. Humerus is reshaped to fit the prosthesis. Metal ball with stem is fitted into humerus canal Stem, it provides anchorage to the prosthesis. Metal ball serves as humerus head. Surgeon shapes the glenoid surface to relieve the prosthesis. A cup shaped shallow prosthesis made of plastic is cemented to glenoid.

Recovery after surgery

Patients will be discharged usually after 4 to 5 days after surgery. Shoulder habitation is started. Gentle movements of shoulder are performed with help of physiotherapist for first 4 to 6 weeks. Patient should gradually work to increase the strength and movement in the shoulder. Normally it takes 5 to 6 months to resume their daily activities following surgery.

Prognosis – what to expect after total shoulder replacement.

Total shoulder replacement has a high success rate if performed under an experienced orthopaedition . Patients will be able to perform their normal daily activities like walking, swimming without pain. With proper exercises and avoiding excessive stress activities the longevity of prosthesis increases. Average longevity of prosthesis is 15 years, but it may vary for individual patients.

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