Dr Graeme MacDougal

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Surgical Treatment of Shoulder Arthritis

Surgical treatments for arthritis of the shoulder have improved greatly over the past ten years and a number of procedures are available for the treatment of arthritic conditions of the joints, including the shoulder.
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Arthroscopy showing osteoarthritis

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Osteoarthritis and loose body

Arthritis of the shoulder may be caused by age-related osteoarthritis (wear and tear), injury related arthritis (post-fracture and dislocations), chronic inflammatory disease (rheumatoid arthritis), avascular necrosis and occasionally post-surgical arthritis.

Initial treatment for arthritic conditions once identified and diagnosed should include a trial of non-operative management, either managed by a General Practitioner or Surgeon or Physician of choice, and includes the use of anti-inflammatory medication, modification of activities, application of ice, oral analgesics and anti-inflammatory corticosteroid injection.

If these measures are not successful in controlling symptoms, surgical intervention is indicated in the management of shoulder arthritis. Arthritis causes stiffness, pain (particularly at night) and is often increased by excess activity.

Shoulder arthritis affects the main joint between the humerus (upper arm) and the glenoid (the shoulder socket).

The loss of cartilage, cartilage wear, loose bodies and inflammation of the joint (synovitis) produce the pain and stiffness.

Early on in the course of arthritic conditions when bony changes are minor, and where inflammation of the joint causes pain, arthroscopic surgery may have a role in reducing shoulder symptoms by cleaning out the joint and removing the lining (synovium) of the joint. This is called a Synovectomy of the joint lining.

A Synovectomy has a limited role in the very early cases, where bone changes are minimal. As the bony changes progress in the arthritic condition, arthroscopy is less effective in treating the symptoms.When non-operative treatments have been unsuccessful and arthroscopy does not appear to be a viable option, shoulder arthroplasty (joint replacement) is available for treatment of the arthritis. Essentially with joint replacement, a new surface is placed on the socket or glenoid side (cup), and a new humeral head and stem is inserted into the humerus to replace the worn out ball of the joint. A prerequisite for a successful standard Total Shoulder Replacement is reasonable quality rotator cuff tendon integrity. Should the rotator cuff tendons be of poor quality, complications for shoulder replacement and success with the procedure may be compromised.

In the situation where tendon quality is poor and the rotator cuff tears are significant, consideration should be given to using a Reverse Total Shoulder Replacement for treatment of the symptoms. In this procedure the ball is placed on the standard glenoid and a socket is created by prosthesis in the humerus. The biomechanical function of the Reverse Total Shoulder Replacement relies on the integrity and good function of the deltoid muscle irrespective of the quality of the rotator cuff tendon, and is an excellent solution for conditions such as rotator cuff arthropathy, arthritis with severe rotator cuff tears and on occasion, post-traumatic arthritis where marked deformity of the bony anatomy is present in association with rotator cuff pathology.
Glenohumeral Osteoarthritis - Total Shoulder Replacement

Left - Glenohumeral Osteoarthritis Right - Total Shoulder Replacement

It should be noted that shoulder replacement is a very technical procedure requiring high skill and experience to achieve the best results. It requires a thorough explanation to the patient, high quality surgical procedure, a thorough and supervised physiotherapy programme postoperatively and excellent patient compliance for best outcomes.

Further information regarding shoulder surgery for the treatment of arthritis can be obtained from Dr MacDougal.
  Any surgical or invasive procedure carries risks. Should you wish to discuss your options for shoulder arthritis with Dr MacDougal, please make an appointment to do so in order that your individual treatment needs can be prescribed for your particular situation.

Graeme MacDougal Shoulder and Elbow Surgeon