Our Summary

This research paper is about a common form of shoulder joint disease called primary osteoarthritis. The disease destroys the joint and causes inflammation in its lining, and it seems to be largely determined by genetics. Symptoms include shoulder pain and a gradual limitation of movement. To diagnose this condition, doctors can use a physical exam, X-rays, and MRI scans, specifically looking at the rotator cuff.

The severity of the disease is classified based on the formation of bony spurs on the upper arm bone, the shape of the shoulder socket, and any changes in the roundness of the upper arm bone. Treatment options can include painkillers applied directly to the skin or taken orally, injections of corticosteroids or hyaluronic acid, and physical therapy.

If these non-surgical treatments don’t work, a type of surgery called the comprehensive arthroscopic management (CAM) procedure can be performed. This is typically for younger patients with early-stage disease. For more advanced cases, a joint replacement might be necessary.

FAQs

  1. What are the signs and symptoms of primary osteoarthritis of the shoulder?
  2. What diagnostic measures are used in assessing shoulder osteoarthritis?
  3. What are the treatment options for shoulder osteoarthritis, particularly in advanced stages?

Doctor’s Tip

One helpful tip a doctor might tell a patient about shoulder replacement is to follow a comprehensive rehabilitation program after surgery to ensure a successful recovery. This may include physical therapy exercises to improve range of motion and strength in the shoulder, as well as proper pain management techniques. It is important for patients to adhere to their rehabilitation plan and communicate any concerns or setbacks with their healthcare provider.

Suitable For

Patients who are typically recommended for shoulder replacement surgery are those with primary osteoarthritis of the shoulder who have not had success with non-surgical treatments such as medication, injections, and physical therapy. These patients experience shoulder pain and progressive loss of range of motion, which significantly impacts their daily activities. In some cases, patients may also have associated synovitis.

The decision to undergo shoulder replacement surgery is typically made after a thorough evaluation, including a clinical examination and imaging studies such as X-rays and MRI to assess the extent of joint damage. Classification systems may also be used to determine the severity of the arthritis, including the presence of osteophytes, glenoid morphology, and loss of humeral sphericity.

Younger patients with early-stage osteoarthritis may be considered for joint-preserving arthroplasty procedures, such as the comprehensive arthroscopic management (CAM) procedure. However, patients with advanced-stage osteoarthritis may benefit from endoprosthetic joint replacement, where the damaged joint is replaced with an artificial implant.

Overall, shoulder replacement surgery is recommended for patients who have significant pain and functional limitations due to primary osteoarthritis of the shoulder, and who have not had success with other treatment options.

Timeline

Before shoulder replacement:

  • Patients experience shoulder pain with progressive impairment of both active and passive range of motion.
  • Diagnostics include clinical examination, native radiography, and MRI for assessment of the rotator cuff.
  • Non-surgical measures such as analgesics, corticosteroid injections, hyaluronic acid injections, and physiotherapy are attempted.

After shoulder replacement:

  • Arthroscopic joint-preserving arthroplasty may be performed in young patients with early stage osteoarthritis.
  • In advanced stages, endoprosthetic joint replacement is indicated.
  • Recovery and rehabilitation following surgery may involve physical therapy and pain management.
  • Patients typically experience improved shoulder function and reduced pain after the procedure.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with shoulder replacement surgery?
  2. What is the typical recovery time and rehabilitation process after shoulder replacement surgery?
  3. How long can I expect the shoulder replacement to last before needing a revision surgery?
  4. Will I be able to regain full range of motion and function in my shoulder after the surgery?
  5. Are there any specific lifestyle changes or limitations I will need to follow after the surgery?
  6. What type of implant will be used in the shoulder replacement and why?
  7. How many shoulder replacement surgeries have you performed and what is your success rate?
  8. Are there any alternative treatment options I should consider before opting for shoulder replacement surgery?
  9. How should I prepare for the surgery, both physically and mentally?
  10. What can I expect in terms of pain management during and after the surgery?

Reference

Authors: Tauber M, Martetschläger F. Journal: Orthopade. 2019 Sep;48(9):795-808. doi: 10.1007/s00132-019-03792-9. PMID: 31432200