Total Joint Replacement
How the Shoulder works?
The shoulder, a ball-and-socket
joint, is the most flexible joint in the body.
The ball , or head, of the humerus is held against
the small, shallow socket by muscles and other
soft tissue structures. A healthy shoulder allows
you to move your arm up and, to the side, across
the body, and behind the back.
A healthy shoulder glides smoothly in the socket
because the ends of the bones are cushioned by
a smooth covering, and tissue lines the joint.
The muscles and tendons of the rotator cuff hold
the head of the arm bone firmly in the socket
and give strength, mobility and stability.
- The glenoid is the shallow socket
that forms a cradle for the head of the arm
- The humeral head is the top part
of the arm bone and is held against the shoulder
- The cartilage is the smooth covering
on the ends of the bones. It acts like a cushion,
allowing the bones to move without pain.
- The synovium lines the capsule and
produces a fluid that lubricates the joint.
- The capsule is composed of ligament
fibers surrounding the joint, guiding movement
of the joint.
- The rotator cuff is a group of strong
muscles and tendons that attach the humerus
to the scapula, controlling the shoulder movement.
- The tuberosities are the points
where the rotator cuff attaches to the arm
What most people call the shoulder is really several
joints that combine with tendons and muscles to allow
a wide range of motion to the arm-from scratching your
back to throwing the perfect pitch. Mobility has its
price, however. It may lead to increasing problems with
instability or impingement of soft tissue resulting
in pain. You may feel pain only when the shoulder is
moved, or all of the time. The pain may be temporary
and disappear in a short time, or it may continue and
require medical diagnosis and treatment.
What causes shoulder pain?
Most shoulder problems involve the soft tissues – muscles,
ligaments and tendons-rather than bones. And most of
these problems fall into three major categories:
- Tendonitis / bursitis
- Injury / instability
Other much more rare causes of shoulder pain are tumors,
infection and nerve-related problems.
Tendonitis: A tendon is a cord which connects
muscle to bone or other tissue. Most tendonitis is a
result of the wearing process that takes place over
a period of years, much like the wearing process on
the sole of a shoe of a which eventually splits from
overuse . Generally tendonitis is one of several types:
- acute tendinitis following some overuse problem
such as excessive ball throwing and other sports-or
- Chronic tendinitis resulting from degenerative
disease or repetitive wear and tear due to age.
- The splitting and tearing of tendons, which may
result from acute injury or degenerative changes in
the tendons due to advancing age. Rotator cuff injuries
are among the most common of these disorders. The
rotator cuff is the arrangement of muscles and their
tendons, which provides shoulder motion and stability.
Sometimes, excessive use of the shoulder leads to
inflammation and swelling of a bursa, a condition
known as bursitis. Bursas are fluid-filled sacs located
around the joints which lessen the friction caused
by movement of the shoulder. Bursitis often occurs
in association with rotator cuff tendinitis. Sometimes
the many tissues in the shoulder become inflamed and
painful, limiting the use of the shoulder. The joint
may stiffen as a result, a condition called a "frozen
shoulder." Fortunately, with appropriate care, this
condition will resolve itself.
Injury / Instability: Sometimes the bones in
one of the shoulder joints move out of their normal
position. This condition, instability, can result in
dislocation of one of the joint in the shoulder. Recurring
dislocations, which may be partial or complete, cause
pain and unsteadiness when you raise your arm or move
it away from your body. When you lift your arm over
your head, the shoulder may feel as if it is slipping
out of place or an uncomfortable, unusual feeling that
some people refer to as having a "dead" arm.
Arthritis: Shoulder pain can also result from
arthritis. There are many types of arthritis, but generally
it involves wear and tear changes with inflammation
of the joint, causing swelling pain and stiffness. Arthritis
may be related to sports or work injuries. Often people
will avoid shoulder movements in an attempt to lessen
the pain arising from these conditions. This some times
leads to a tightening or stiffening of the soft tissue
parts of the joint, resulting in a painful restriction
Treatment generally involves altering activities,
rest, and physical therapy to help you improve shoulder
strength and flexibility. Medication may be prescribed
to reduce inflammation and reduce pain. If medication
is prescribed to relieve pain, it should be taken only
as directed. Injections of drugs may also be used to
treat pain. Surgery may be required to resolve shoulder
problems; however, 90 percent of patients with shoulder
pain will respond to simple treatment methods such as
altering activities, rest, exercise, and medication.
Certain types of shoulder problems, such as recurring
dislocation and some rotator cuff tears, may require
DIAGNOSIS OF SHOULDER PAIN
Determining the source of the problem in the shoulder
is essential to recommending the right method of treatment.
Therefore, a comprehensive examination will be required
to find the causes of your shoulder pain. The first
step is a thorough medical history. Your orthopaedic
surgeon may ask how and when the pain started, whether
it has occurred before and how it was treated, and other
questions to help determine your general health as well
as the possible causes of your shoulder problem. Because
many shoulder conditions are aggravated by specific
activities and relieved by specific activities a medical
history can be valuable tool in finding the source of
and treating your pain. Next, your orthopaedist will
perform a physical examination, which may include looking
for physical abnormalities swelling, deformity or muscle
weakness or feeling for tender areas, and observing
the range of shoulder motion how far and in which direction
you can move your arm.
X-ray studies may be required so your orthopaedist can
look closely at the bones and joints in your shoulder.
Other diagnostic techniques that may be used include
computerized tomography, which provides a more detailed
view of the shoulder area, electrical studies such as
the electromyogram, an x-ray study in which dye is injected
into the shoulder to allow the orthopaedist to better
see the joint and its surrounding muscles and tendons.
Magnetic resonance imaging and ultrasound are other
valuable diagnostic tools for orthopaedists, because
they provide images of the soft tissues without using
Arthroscopy is a surgical procedure in which the orthopaedist
looks inside the joint with a lighted telescope. It
is sometimes used to diagnose causes of shoulder pain.
Arthroscopy may indicate soft tissue injuries that are
not apparent in the physical examination, x-rays and
RESTORING ARM MOVEMENT
If you suffer from a stiff, painful shoulder, you
probably avoid many of the activities that you used
to enjoy. Even simple tasks like brushing your hair,
dressing yourself, or carrying groceries can be difficult
without full use of your shoulder. Depending on the
cause, there are many ways to treat the pain in your
shoulder. One way is through shoulder replacement surgery.
Shoulder replacement has reduced the pain and improved
the lives of thousands of patients. In fact, more than
a half million shoulder replacements have been performed
in the United States alone. And more than a 20,000 new
patients undergo this surgery every year.
This first modern shoulder replacement surgery was performed
in 1953. Since then, the implants and the techniques
have steadily improved. Although nobody can guarantee
a perfect outcome for you, shoulder replacement can
lead to less pain, greater strength and better movement
in the shoulder. The decision to have shoulder replacement
is not an easy one to make. There are many factors to
consider. And after careful consultation with your doctor
and loved ones, only you can make the final decision.
This flyer will help answer some of the questions you
may have. If you have additional questions, or want
more details about the points discussed here, do not
hesitate to talk to your doctor.
WHAT IS SHOULDER REPLACEMENT
In shoulder replacement surgery, the parts of the bones
that rub together are resurfaced with metal and plastic
implants. Using special, precision instruments, your
surgeon will remove the damaged parts of the bones.
The replacement parts will then be fixed into place.
The part that replaces the ball consists of a partial
sphere made of metal. This partial sphere sits on top
of a long metal stem that fits down into the shaft of
the upper arm bone. The part that replaces the socket
consists of an oblong plastic disk with a cupped surface.
The partial sphere fits into this cupped surface to
create the joint. Often, both parts of the joint are
replaced; however, sometimes it may only be necessary
to replace the ball portion of the joint. Your surgeon
will determine what is best for you.
RESTORING ARM MOVEMENT
If you suffer from a stiff, painful elbow, you probably
avoid many of the activities that you used to enjoy. Even
simple tasks like brushing your hair, dressing yourself,
or carrying groceries can be difficult without full use
of your elbow. Depending on the cause, there are many
ways to treat the pain in your elbow. One way is through
total elbow replacement surgery. Elbow replacement has
reduced the pain and improved the lives of thousands of
The first modern total elbow replacement surgery was
performed in 1971. since then, the implants and the
techniques have steadily improved. Although nobody can
guarantee a perfect out-come for you, elbow replacement
can lead to less pain, greater strength, and better
movement in the elbow. The decision to have total elbow
replacement is not an easy one to make. There are many
factors to consider, and after careful consultation
with your doctor and loved ones, only you can make the
WHAT IS TOTAL ELBOW REPLACEMENT?
In total elbow replacement surgery, the damaged parts
of the bones that grind together are replaced with metal
and plastic implants. Using special, precision instruments,
your surgeon will remove the damaged portions of the
ulna and humerus. The replacement parts will then be
fixed in to place. The replacement parts consist of
two long metal stems that fit down in to the shafts
of bones. The two stems are then connected at the ends
by a metal pin, which fits into a plastic bearing. This
bearing will allow you to bend your elbow without allowing
the arthritic bones to contact each other.