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

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