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Total Joint Replacement


Shoulder


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 bone.
  • The humeral head is the top part of the arm bone and is held against the shoulder socket.
  • 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 bone.


SHOULDER PAIN

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
  • Arthritis

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 work-related activities.
  • 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 of motion.

TREATMENT

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 surgery.

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 radiation.

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 other tests.


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.


Elbow


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 patients.

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 final decision.

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.


 

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