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Indications
for Shoulder Replacement
When conservative
methods of treatment fail to provide adequate relief of your
shoulder arthritis or irreparable rotator cuff tear, total shoulder
replacement is considered.
The development of
total shoulder replacement began over 40 years ago, and over 15,000
people in the U.S.A. each year undergo this surgery to
diminish pain and stiffness and restore mobility.
If
your x-rays show destruction of the joint, your surgeon will decide
if your degree of pain and loss of use is severe enough to warrant
the operation.
The
primary purpose of the operation is to relieve your pain. The
secondary purpose is to increase your range of motion. The extent of
improvement in your range of motion will depend on a number of
factors including the severity of the arthritis and the degree of
stiffness before the surgery. The effort put into the intense
postoperative rehabilitation will also play a major role.
Total
joint replacement is a remarkably successful operation that has
transformed the lives of many people.
The main indications for a shoulder
replacement are:
1. Advanced arthritis
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While
osteoarthritis of the knee and hip (the weight bearing
joints) are common, osteoarthritis of the shoulder joint is
a relatively uncommon condition. Nevertheless when it does
occur it is at least as painful and debilitating. You may
know many friends who have undergone hip and knee
replacements, yet not have heard of a shoulder replacement.
It is because shoulder arthritis is much rarer. However, the
results of shoulder replacement are at least as good as that
for the knee or hip replacements.
Other forms of arthritis
which can damage the shoulder joint include a number of
rheumatoid type conditions and post-traumatic arthritis
which occurs after an injury to the joint such as a
dislocation or fracture.
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2. Arthritis following advanced
rotator cuff tears (CTA)
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Wear and tear of most
joints result in osteoarthritis. The shoulder joint differs
in that wear and tear of the tendons around the joint are
much more common. The tendons called the rotator cuff
tendons are commonly torn as a consequence of wear and
tear. This is usually treated with a repair of the tendons.
However, if the wear and tear is advanced, repair may not be
possible. Imagine the tear being like a worn sock which
quickly develops are large hole. Once the fabric has worn
out, it would not be repairable.
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When
the rotator cuff has a large tear, the should
"dislocates" upward because the tendons
responsible for holding the joint together have failed. This
results in pain and the ability to lift the arm up. An
arthritis of the joint ensues, called a cuff tear
arthropathy or CTA.
The black arrow
indicates the potential space between the humeral head and
the acromion (a part of the bone of the scapula, or shoulder
blade). The rotator cuff tendons no longer fill this space.
The humeral head now rides upward ,indicated by the white
arrow, and abuts on the acromion.
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Click
here for more information about Shoulder replacements
for CTA
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