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Understanding Chronic Shoulder Pain
 

Understanding Chronic Shoulder Pain

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Bradley M. Saunders, MD, gave this presentation Nov. 20, 2013, for a Via Christi health 50+ Lunch and Learn.

Bradley M. Saunders, MD, gave this presentation Nov. 20, 2013, for a Via Christi health 50+ Lunch and Learn.

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  • All can limit your activities, keep you from everyday tasks, and make it hard to sleep at night. <br />
  • There are generally three shoulder replacement procedures. <br />
  • Find an orthopedic surgeon who specializes in shoulders. Shoulder replacement is complex, and may be better performed by a shoulder specialist rather than someone who does primarily knees and hips <br /> There are generally three procedures for shoulder replacement: <br /> Primary, <br /> Reversed <br /> Shoulder Resurfacing <br />
  • The primary indication is pain which will not respond to non-operative treatment <br /> Procedure: <br /> Ball of the shoulder joint is replaced with an implant that includes a stem with a smooth, rounded metal head. The socket is replaced with a smooth, rounded plastic cup that fits the head of the ball. <br /> Objective: <br /> Restoration of function and pain relief <br />
  • The primary indication is pain which will not respond to non-operative treatment and insufficient or irreparable rotator cuff. <br /> Procedure: <br /> The normal structure of the shoulder is “reversed” The ball portion of the implant is attached to the scapula and the artificial socket is attached to the humeral head. <br /> Objective: <br /> Restoration of function and pain relief <br />
  • Procedure: <br /> With this procedure, the damaged humeral head is sculpted to receive a metal “cap” that fits onto the bone, functioning as a new, smooth humeral head. <br /> Objective: <br /> Restoration of function and pain relief <br />
  • Complexity with glenoid replacement <br /> Many surgeons are not proficient in glenoid access <br /> May fall back on doing a “hemi” prosthesis, avoiding glenoid replacement, which is not optimal for best patient results <br />

Understanding Chronic Shoulder Pain Understanding Chronic Shoulder Pain Presentation Transcript

  • UNDERSTANDING AND ADDRESSING CHRONIC SHOULDER PAIN CAW-2273 Rev. A
  • Do You Have Chronic Shoulder Pain? CAW-2273 Rev. A
  • Are Your Daily Living Activities Limited? CAW-2273 Rev. A
  • Symptoms • Chronic Pain • Compromised Shoulder Function • Combination-both pain and compromised function CAW-2273 Rev. A
  • Normal Shoulder: Bone Anatomy Humeral Head (Ball) Clavicle Scapula (Shoulder Blade) Humerus Glenoid (Socket) CAW-2273 Rev. A
  • Some Causes of Shoulder Pain & Compromised Function CAW-2273 Rev. A
  • Arthritis CAW-2273 Rev. A
  • Fracture CAW-2273 Rev. A
  • Shoulder Dislocation CAW-2273 Rev. A
  • How Do I Manage the Pain? CAW-2273 Rev. A
  • Short Term Treatment Options • Non-surgical • • • • Lifestyle changes Physical therapy Medications Injections CAW-2273 Rev. A
  • Long Term Solution Shoulder Replacement may be an option for you 1. Primary total shoulder replacement 2. Reversed total shoulder replacement 3. Shoulder resurfacing CAW-2273 Rev. A
  • Shoulder Pain – A Common Problem Shoulder Replacemen t 3rd most common type of joint replacement CAW-2273 Rev. A
  • Safe, Reliable, Effective Solution Studies prove that shoulder replacement is just as safe and effective in relieving pain and restoring mobility as hip or knee replacement. “In a study of patients with shoulder pain, more than 95% reported having less pain after shoulder replacement.” 1 Farmer KW, Hammond JW, Queale WS, Keyurapan E, McFarland EG. Shoulder arthroplasty versus hip and knee arthroplasties: a comparison of outcomes. Clin Orthop Rel Res 2007;455:183-9. CAW-2273 Rev. A
  • Steps to a Solution Talk with your surgeon to determine the best treatment option for you CAW-2273 Rev. A
  • Primary Total Shoulder Replacement The Humeral Head (ball) is replaced with a stem and head prosthesis. The Glenoid (socket) is replaced with a rounded, specialized plastic implant. CAW-2273 Rev. A
  • Implanted Primary Shoulder Device CAW-2273 Rev. A
  • Reversed Total Shoulder Replacement A “Reversed” implant reverses the normal ball and socket configuration. The humeral head is replaced by a stem and a plastic ‘socket,’ and the glenoid is replaced with a ball. CAW-2273 Rev. A
  • Implanted Reversed Shoulder Device CAW-2273 Rev. A
  • Normal Shoulder: Rotator Cuff Anterior View Supraspinatus Muscle • Reversed Shoulder replacement is often an option for patients with compromised rotator cuff function Subscapularis Muscle CAW-2273 Rev. A
  • Resurfacing Head With humeral head resurfacing, a ‘cap,’ or a resurfacing head implant, is placed over the existing, damaged humeral head. This relieves pain and restores function for some patients. CAW-2273 Rev. A
  • Shoulder Replacement Device Glenoid Keeled Glenoid Primary Total Stem and Head Resurfacing Head Reversed for Fracture Reversed Total Primary Total Press Fit CAW-2273 Rev. A
  • The Value of Shoulder Specialists  75% of shoulder replacements are performed by general orthopedic surgeons, doing only 1-2 cases per year* *Hasan SS, Leith JM, Smith KL, and Matsen FA, 3rd. The distribution of shoulder replacement among surgeons and hospitals is significantly different than that of hip or knee replacement. J Shoulder Elbow Surg 12: 164-169, 2003. CAW-2273 Rev. A
  • The Value of Shoulder Specialists  Study showed direct correlation between surgeon volume and patient outcomes *Nitin J et. Al. The relationship between surgeon volume and hospital volume and outcomes for shoulder arthroplasty. J Bone Joint Surg Am. 2004;86:496-505. CAW-2273 Rev. A
  • Pre-Surgery Considerations I’ve elected to have shoulder replacement… – Are interactions with my current medications a concern? – What kind of after surgery help will I need? – Is there anything I can do in advance of surgery that will make the recovery process easier? CAW-2273 Rev. A
  • Surgery: What to Expect – Performed in the hospital by an experienced, specialized surgical team – An incision about 4-8 inches long is made in the front of the shoulder in order to receive the implant – The site is prepared, necessary components are placed, and the incision is closed – Generally takes 1-3 hours CAW-2273 Rev. A
  • Recovery: Post-Surgery Your recovery will be determined by your doctor: – A hospital stay may or may not be required – Most people are able to return to normal daily activities within the first two weeks – Your physician will tell you when it is safe to drive (generally not until 6 weeks after surgery) and perform other tasks CAW-2273 Rev. A
  • Recovery: Physical Therapy Your rehabilitation program will be determined by your doctor: – Critical to the success of your new shoulder – Often begins as early as the day of your surgery – Involves in-home exercises that must be followed exactly and done regularly – May be required to obtain PT in the clinic CAW-2273 Rev. A
  • Total Recovery Time Recovery time varies with each patient, but on average, total recovery time is approximately 3-6 months. CAW-2273 Rev. A
  • Common Treatment Outcomes Outcomes vary by patient, but can include: – Decrease or elimination of pain – Full or partially restored mobility – Restful sleep – Return to daily tasks and activities CAW-2273 Rev. A
  • Complications As with any surgery, there is always a risk of complications. Although rare, some of the most severe complications associated with shoulder replacement are: • Infection • Dislocation • Postoperative fractures • Glenoid component failure You should talk with your doctor about benefits and risks before proceeding with any treatment option. CAW-2273 Rev. A
  • Patient Testimonial • Add a patient story from your practice, have a patient advocate present, play the Tornier Patient Testimonial DVD. CAW-2273 Rev. A
  • Overall Patient Satisfaction   Achieve the goal of relieving pain and restoring function for your patients “99% of the people who have a shoulder replacement for arthritis get pain relief and say that they wish they had done it sooner.”* 1 Farmer KW, Hammond JW, Queale WS, Keyurapan E, McFarland EG. Shoulder arthroplasty versus hip and knee arthroplasties: a comparison of outcomes. Clin Orthop Rel Res 2007;455:183-9. CAW-2273 Rev. A
  • Key Decision-Making Considerations I need help deciding… – – – – – – – – – Am I a good candidate for this surgery? Will insurance cover it? What outcome can I expect? Are there any side effects or complications? Will I have pain? How long is the recovery period? What kind of help will I need? What long-term restrictions will I have? When can I return to daily activities, i.e. work, hobbies, volunteering…? CAW-2273 Rev. A
  • Success Factors – Condition and quality of the bone – Type and severity of arthritis – Condition of the muscles around the shoulder – Your age, activity level and overall health – Your commitment to rehabilitation after surgery CAW-2273 Rev. A
  • You Don’t Have to Suffer! • You do not have to suffer from shoulder pain and compromised mobility • Non-surgical and surgical treatment options • You can have an improved quality of life and return to your normal activities CAW-2273 Rev. A
  • Questions & Answers Thank You CAW-2273 Rev. A