The shoulder joint is one of the most complex and most mobile joint in the human body. It can be moved in any of the three dimensions to nearly 360 deg of movements. Being such a mobile joint, it is the most unstable joint and is prone to dislocations. These dislocations are usually simple and easily reducible and don't harm much the surrounding soft tissues such as labrum or the rotator cuff.
But, in a certain subset of the young and active group of people having repeated episodes of dislocation with associated labral or cuff tear or the impingement, Arthroscopic repair of the labral tears or the rotator cuff tear does wonders and gives them stable, pain-free joint and a near-normal lifestyle for the patients.
Total Shoulder Arthroplasty is an evolving and most successful procedure for treating people with severe painful shoulder and also shoulder stiffness that is often the result of the end stage of arthritis. Primary aim being the pain relief with a secondary benefit of restoring movements, strength and function.
Most common conditions affecting shoulder are
- Periarthritis Shoulder
- Painful Arc Syndrome
- Impingement
- Posttraumatic Arthritis
- Rheumatoid Arthritis
- Chronic Rotator Cuff Tear and Tendinopathy
- Subacromial bursitis with acromial spur
In the early stages of the above conditions, they do respond very well to the Anti-inflammatory medication and Physiotherapy. 90-95% of the patients with the first 3 conditions do recover with physiotherapy and medications.
Patients who are contraindicated for surgery
- Those who aren't restricting their daily activity
- Power loss/ Paralysis of the rotator cuff and deltoid
- Those patients with progressive disease of the nervous system
In the surgery, depending on the cuff integrity, a Total Shoulder or a Reverse Shoulder Replacement should be planned. In the Total Shoulder Arthroplasty, the worn out/ diseased glenoid is replaced by the socket and the worn out humeral head is replaced by the ball and the cuff has to be well preserved and sutured back.
Reverse Shoulder Arthroplasty is opted for patients where the cuff is damaged or degenerated significantly and also in cases of gross stiffness with chronic rotator cuff tears, where the glenoid is replaced with a spherical ball and a socket is made over the proximal humerus to give more stability, preserving the deltoid for the mobility and functionality. It is the most promising surgery in cuff arthropathy or tendinopathy.
Usually, patients do stay in the hospital for 2-3 days. Hand and wrist movements are started immediately post surgery. Assisted/ gentle shoulder movements and strengthening for 4-6 weeks. Patients can get back to desk work in 2 weeks time. Active shoulder movements/exercises from 6-12 weeks, and in 3 months post surgery they can get back to their normal lifestyle.
We would conclude that TSA is a highly beneficial surgical procedure intending in pain relief and restore mobility in patients with end-stage of shoulder arthritis. With the proper patient selection, considering the general, neurological status of the patient as well as the patient's expectations post-surgery.
It is important to understand that proper and extensive physiotherapy is a key factor in achieving maximum benefits of the surgery.
Never think twice to converse with a physio for medication and before proceeding for surgery.