UNDERSTANDING
AND ADDRESSING
CHRONIC
SHOULDER PAIN

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Do You Have Chronic Shoulder Pain?

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Are Your Daily Living Activities Limited?

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Symptoms
• Chronic Pain
• Compromised Shoulder
Function
• Combination-both pain
and compromised function

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Normal Shoulder: Bone Anatomy
Humeral Head
(Ball)

Clavicle
Scapula
(Shoulder
Blade)

Humerus
Glenoid
(Socket)
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Some Causes of Shoulder Pain &
Compromised Function

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Arthritis

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Fracture

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Shoulder Dislocation

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How Do I Manage the Pain?

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Short Term Treatment Options
• Non-surgical •
•
•
•

Lifestyle changes
Physical therapy
Medications
Injections

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Long Term Solution
Shoulder Replacement may be
an option for you 1. Primary total shoulder
replacement
2. Reversed total shoulder
replacement
3. Shoulder resurfacing

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Shoulder Pain – A Common Problem
Shoulder
Replacemen
t

3rd most common type of joint
replacement

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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.

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Steps to a Solution
Talk with your surgeon to determine the best
treatment option for you

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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.

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Implanted Primary Shoulder
Device

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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.

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Implanted Reversed Shoulder
Device

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Normal Shoulder: Rotator Cuff
Anterior View
Supraspinatus Muscle

• Reversed Shoulder
replacement is often
an option for patients
with compromised
rotator cuff function

Subscapularis Muscle
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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.
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Shoulder Replacement Device

Glenoid

Keeled
Glenoid

Primary Total
Stem and Head

Resurfacing
Head
Reversed
for
Fracture

Reversed
Total

Primary
Total Press
Fit
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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
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Total Recovery Time

Recovery time varies
with each patient, but
on average, total
recovery time is
approximately 3-6
months.

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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

Understanding Chronic Shoulder Pain

  • 1.
  • 2.
    Do You HaveChronic Shoulder Pain? CAW-2273 Rev. A
  • 3.
    Are Your DailyLiving Activities Limited? CAW-2273 Rev. A
  • 4.
    Symptoms • Chronic Pain •Compromised Shoulder Function • Combination-both pain and compromised function CAW-2273 Rev. A
  • 5.
    Normal Shoulder: BoneAnatomy Humeral Head (Ball) Clavicle Scapula (Shoulder Blade) Humerus Glenoid (Socket) CAW-2273 Rev. A
  • 6.
    Some Causes ofShoulder Pain & Compromised Function CAW-2273 Rev. A
  • 7.
  • 8.
  • 9.
  • 10.
    How Do IManage the Pain? CAW-2273 Rev. A
  • 11.
    Short Term TreatmentOptions • Non-surgical • • • • Lifestyle changes Physical therapy Medications Injections CAW-2273 Rev. A
  • 12.
    Long Term Solution ShoulderReplacement may be an option for you 1. Primary total shoulder replacement 2. Reversed total shoulder replacement 3. Shoulder resurfacing CAW-2273 Rev. A
  • 13.
    Shoulder Pain –A Common Problem Shoulder Replacemen t 3rd most common type of joint replacement CAW-2273 Rev. A
  • 14.
    Safe, Reliable, EffectiveSolution 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.
    Steps to aSolution Talk with your surgeon to determine the best treatment option for you CAW-2273 Rev. A
  • 16.
    Primary Total ShoulderReplacement 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.
  • 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.
  • 20.
    Normal Shoulder: RotatorCuff 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.
    Resurfacing Head With humeralhead 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.
    Shoulder Replacement Device Glenoid Keeled Glenoid PrimaryTotal Stem and Head Resurfacing Head Reversed for Fracture Reversed Total Primary Total Press Fit CAW-2273 Rev. A
  • 23.
    The Value ofShoulder 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.
    The Value ofShoulder 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.
    Pre-Surgery Considerations I’ve electedto 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.
    Surgery: What toExpect – 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.
    Recovery: Post-Surgery Your recoverywill 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.
    Recovery: Physical Therapy Yourrehabilitation 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.
    Total Recovery Time Recoverytime varies with each patient, but on average, total recovery time is approximately 3-6 months. CAW-2273 Rev. A
  • 30.
    Common Treatment Outcomes Outcomesvary 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.
    Complications As with anysurgery, 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.
    Patient Testimonial • Add apatient story from your practice, have a patient advocate present, play the Tornier Patient Testimonial DVD. CAW-2273 Rev. A
  • 33.
    Overall Patient Satisfaction   Achievethe 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.
    Key Decision-Making Considerations I needhelp 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.
    Success Factors – Conditionand 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.
    You Don’t Haveto 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.
    Questions & Answers ThankYou CAW-2273 Rev. A

Editor's Notes

  • #5 All can limit your activities, keep you from everyday tasks, and make it hard to sleep at night.
  • #13 There are generally three shoulder replacement procedures.
  • #16 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: Primary, Reversed Shoulder Resurfacing
  • #17 The primary indication is pain which will not respond to non-operative treatment Procedure: 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. Objective: Restoration of function and pain relief
  • #19 The primary indication is pain which will not respond to non-operative treatment and insufficient or irreparable rotator cuff. Procedure: 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. Objective: Restoration of function and pain relief
  • #22 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. Objective: Restoration of function and pain relief
  • #24 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