OPDDr.L H Hiranandani Hospital, Powai
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Your shoulders are the location of your body’s most mobile joints. Shoulder joints take a lot of wear and tear and therefore have the potential to get damaged. Shoulder arthritis generally causes symptoms such as joint pain and limited range of motion. But there’s more than one kind of arthritis of the shoulders. The American academy of orthopaedic surgeons (AAOS) recognises five varieties of arthritis
Also known as “wear-and-tear” arthritis, osteoarthritis is a condition that destroys the smooth outer covering (articular cartilage) of bone. As
Osteoarthritis usually affects people over 50 years of age and is more common in the acromioclavicular joint than in the glenohumeral shoulder joint.
Cuff Tear Arthropathy
Arthritis can also develop after a large, long-standing rotator cuff tendon tear. The torn rotator cuff can no longer hold the head of the humerus in the glenoid socket, and the humerus can move upward and rub against the acromion. This can damage the surfaces of the bones, causing arthritis to develop.
The combination of a large rotator cuff tear and advanced arthritis can lead to severe pain and weakness, and the patient may not be able to lift the arm away from the side.
Rheumatoid arthritis (RA) is a chronic disease that attacks multiple joints throughout the body. It is symmetrical, meaning that it usually affects the same joint on both sides of the body.
The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move. Rheumatoid arthritis causes the lining to swell, which causes pain and stiffness in the joint.
Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks the body’s own tissues. In RA, the defences that protect the body from infection instead damage normal tissue (such as cartilage and ligaments) and soften bone.
Rheumatoid arthritis is equally common in both joints of the shoulder.
Avascular necrosis (AVN) of the shoulder is a painful condition that occurs when the blood supply to the head of the humerus is disrupted. Because bone cells die without a blood supply, AVN can ultimately lead to destruction of the shoulder joint and arthritis.
Avascular necrosis develops in stages. As it progresses, the dead bone gradually collapses, which damages the articular cartilage covering the bone and leads to arthritis. At first, AVN affects only the head of the humerus, but as AVN progresses, the collapsed head of the humerus can damage the glenoid socket.
Causes of AVN include high dose steroid use, heavy alcohol consumption, sickle cell disease, and traumatic injury, such as fractures of the shoulder. In some cases, no cause can be identified; this is referred to as idiopathic AVN.
Post-traumatic arthritis is a form of osteoarthritis that develops after an injury, such as a fracture or dislocation of the shoulder.
Symptoms / Clinical features:
The progression of shoulder arthritis progresses from an early stage of minimal damage to the cartilage to a late stage of advanced cartilage degeneration. For the management of advanced shoulder arthritis initially a trial of analgesics , physiotherapy and activity modification may be attempted. For recalcitrant cases a shoulder replacement is advisable. There are variety of implants available for the same and essentially two designs are recommended:
Which one is suitable for you will depend on the severity of your problem, clinical examination and the cause. You can choose and come to a conclusion with regards to the same after a discussion with your doctor.
What is Shoulder Replacement
As we have described previously, the shoulder joint consists of a ball and socket articulation. In a total shoulder replacment the ball and socket are replaced with a metallic head (ball) and medical grade UHMWPE socket. As a result of this a rough surface is replaced with a smoother one and symptomatic relief is obtained.
Before undergoing the procedure we would be doing a few tests to assess your fitness for undergoing anaesthesia.Diagnostic testing will typically include:
X rays of the affected joint (and other joints as well)to determine loss of joint space and to differentiate between OA and RA
Imaging studies, such as computed tomography (CT scans), magnetic resonance (MRI), and bone densitometry to assess bone loss or bone infection.
Cardiac tests, such as electrocardiogram, to evaluate the heart and circulatory system blood tests to rule out infection and possibly to confirm arthritis.
Prior to arthroplasty, standard preoperative blood and urine tests are performed to rule out such conditions as anemia and infection. If a patient has a history of bleeding, the surgeon may ask that clotting tests be performed.
You will also have a discussion with the anaesthetist to discuss the options for anaesthesia. You would be admitted in the hospital for about three days after undergoing this procedure. During the first few weeks after this procedure your arm will be supported by a sling following which exercises are started to gain strength and movement in the shoulder. A well done shoulder replacement is an extremely gratifying surgery for the patient in the long run with regards to pain relief and function.
Pre Operative video of an individual with shoulder arthritis
Post Operative Video of an individual undergone total shoulder replacement , six months after the surgery.
What is a reverse shoulder arthroplasty
A reverse shoulder arthroplasty is a procedure in which the conventional Head and socket relationship of the shoulder is inverted. An extremely complicated procedure, it is being done only by a handful of surgeons in India, and Dr. Aditya Sai Kadavkolan is one of them. A reverse shoulder arthroplasty is done in individuals with severe forms of arthritis and in case of arthritis with rotator cuff tears. Again the procedure is extremely gratifying for the patient when pain relief and return of function is considered.
Reverse shoulder arthroplasty is performed generally in individuals more than 65 yrs of age, and offers faster return to function. It must be noted though that the primary objective of a Reverse shoulder arthroplasty is