Understanding Chronic Shoulder Pain


Published on

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

Published in: Health & Medicine
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • All can limit your activities, keep you from everyday tasks, and make it hard to sleep at night.
  • There are generally three shoulder replacement procedures.
  • 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
    There are generally three procedures for shoulder replacement:
    Shoulder Resurfacing
  • The primary indication is pain which will not respond to non-operative treatment
    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.
    Restoration of function and pain relief
  • The primary indication is pain which will not respond to non-operative treatment and insufficient or irreparable rotator cuff.
    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.
    Restoration of function and pain relief
  • Procedure:
    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.
    Restoration of function and pain relief
  • Complexity with glenoid replacement
    Many surgeons are not proficient in glenoid access
    May fall back on doing a “hemi” prosthesis, avoiding glenoid replacement, which is not optimal for best patient results
  • Understanding Chronic Shoulder Pain

    2. 2. Do You Have Chronic Shoulder Pain? CAW-2273 Rev. A
    3. 3. Are Your Daily Living Activities Limited? CAW-2273 Rev. A
    4. 4. Symptoms • Chronic Pain • Compromised Shoulder Function • Combination-both pain and compromised function CAW-2273 Rev. A
    5. 5. Normal Shoulder: Bone Anatomy Humeral Head (Ball) Clavicle Scapula (Shoulder Blade) Humerus Glenoid (Socket) CAW-2273 Rev. A
    6. 6. Some Causes of Shoulder Pain & Compromised Function CAW-2273 Rev. A
    7. 7. Arthritis CAW-2273 Rev. A
    8. 8. Fracture CAW-2273 Rev. A
    9. 9. Shoulder Dislocation CAW-2273 Rev. A
    10. 10. How Do I Manage the Pain? CAW-2273 Rev. A
    11. 11. Short Term Treatment Options • Non-surgical • • • • Lifestyle changes Physical therapy Medications Injections CAW-2273 Rev. A
    12. 12. 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
    13. 13. Shoulder Pain – A Common Problem Shoulder Replacemen t 3rd most common type of joint replacement CAW-2273 Rev. A
    14. 14. 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
    15. 15. Steps to a Solution Talk with your surgeon to determine the best treatment option for you CAW-2273 Rev. A
    16. 16. 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
    17. 17. Implanted Primary Shoulder Device CAW-2273 Rev. A
    18. 18. 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
    19. 19. Implanted Reversed Shoulder Device CAW-2273 Rev. A
    20. 20. 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
    21. 21. 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
    22. 22. 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
    23. 23. 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
    24. 24. 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
    25. 25. 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
    26. 26. 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
    27. 27. 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
    28. 28. 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
    29. 29. Total Recovery Time Recovery time varies with each patient, but on average, total recovery time is approximately 3-6 months. CAW-2273 Rev. A
    30. 30. 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
    31. 31. 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
    32. 32. Patient Testimonial • Add a patient story from your practice, have a patient advocate present, play the Tornier Patient Testimonial DVD. CAW-2273 Rev. A
    33. 33. 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
    34. 34. 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
    35. 35. 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
    36. 36. 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
    37. 37. Questions & Answers Thank You CAW-2273 Rev. A