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The board certified physicians and surgeons at Orthopaedic Associates of Central Texas (OACT) are leaders in caring for the joints of the body. The shoulder joint is a complex and dynamic structure, and when injured can cause pain and decreased function. At OACT we care for all types of shoulder trauma, pain, and dysfunction. Our physicians and surgeons have advanced training in caring for shoulder injuries and use the latest advancements in technology to diagnosis, and perform the correct treatment plan to maximize your recovery.
The Shoulder Joint:
Your shoulder is a complex ball and socket joint that links the humerus (the arm bone), the scapula (shoulder blade), and the clavicle (collarbone). Surrounding these bones are the four muscles of the rotator cuff and the biceps tendon, which work together to support and provide the power to position the arm and hand in space. As with the hip, the shoulder’s ball-and-socket arrangement helps ensure freedom of movement in several directions. Within the cavity of the joint is a substance called synovial fluid which promotes smooth movement and helps prevent friction between the two main bones. The surfaces of these bones are covered by a special protective material called articular cartilage. Surrounding the shoulder is a thick fibrous joint capsule whose job is twofold: to hold the synovial fluid within the joint cavity and to keep the joint stable. Smooth, pain-free motion in the shoulder joint depends on healthy cartilage and joint fluid, as well as strong and flexible surrounding ligaments and muscles.
Injury, Trauma, or Aging to the Shoulder Joint:
Joint diseases such as tears to the rotator cuff can result in stiffness, swelling, tenderness, and discomfort in the shoulder, often causing you to slowly restrict your movements. Sometimes trauma (from a sport injury, fall, or car accident, for example) weakens the shoulders ligaments and cartilage. Other times the shoulder joints can weaken just from the normal wear and tear of aging. Whatever the cause, osteoarthritis or rheumatoid arthritis may develop. Even the simplest daily activities can become painful, from taking a shower and dressing yourself in the morning to waving goodbye, flipping a light switch, or even sleeping on your side at night. As your mobility diminishes, so does your quality of life.
Non-surgical Treatment of the Shoulder:
Your physician may determine that your injury is best treated without surgery. Some injuries that are most commonly treated non-operatively are sprains, strains, bruises, bursitis, and some stable fractures. Non-operative treatments include:
- Activity modification
- Cortisone injections
- Physical therapy
Total Shoulder Replacement:
The goal of shoulder replacement surgery is to relieve the pain caused by damage to the cartilage of the joint surfaces and to increase functional range of motion and strength. To determine whether you may need surgery, consult the surgeons at OACT. An orthopaedic surgeon, or certified physician assistant, who specializes in treating shoulder disorders will perform a comprehensive exam to include: a complete medical history, x-rays, assess your range of movement and level of daily function, and other tests to show the extent of damage to the joint. Total shoulder joint replacement will be considered if other treatment options will not relieve your pain and disability.
If you do opt to have the surgery, it would help for you to do some homework ahead of time. Become familiar with the specific exercises you will need to do after surgery. Your activity will be restricted at first. Observe these restrictions to give your shoulder proper time to heal.
Continuing a personal exercise program designed by one of our staff physical therapists at our outpatient physical therapy facility for several months following surgery will help you regain strength. An active lifestyle which includes water exercises, walking, and biking is essential in keeping you healthy and flexible. Gauge your daily activities with your surgery in mind. Avoid strenuous movements such as overhead lifting, forced end range of motion movements, and heavy lifting. After surgery, the shoulder pain you had will be gone, but you may have some discomfort when you stretch, and you may experience some pain at the site of the surgery. This will decrease and disappear over time.
Q) Once I decide to have the surgery, how soon can it actually take place?
A) Once your insurance is approved and medical clearance is granted, the surgery can then be scheduled.
Q) What materials will replace the bones in my shoulder?
A) A metal alloy replaces the ball portion of the shoulder joint, and the socket may or may not be replaced with a high grade plastic.
Q) How painful is total shoulder replacement?
A) As with all forms of surgery, shoulder replacement surgery is painful, but the pain is manageable with narcotic pain medicines and anti-inflammatories. For the first one to two days after surgery, pain is very well controlled with a PCA (patient controlled anesthesia) or intravenous narcotics. After that, oral medications, such as Percocet or Vicodin, are usually adequate. Sometimes patients require further (but less frequent) pain medication once they leave the hospital. Typically within two to three weeks after surgery, most patients find that their pain is greatly diminished and nothing stronger than aspirin or Motrin is needed.
Q) What are the possible complications?
A) During your hospital stay, pneumonia and urinary tract infections are possibilities. Infections are the most common complication and these can be prevented with pre-operative and post-operative antibiotics and gentle exercises which begin soon after surgery.
Q) Is bleeding around the incision after surgery normal?
A) It is not unusual to have some mild bleeding that soaks through the dressing but this should have stopped before you are released from the hospital. Should this happen and you are at home, you should reinforce the dressing with more sterile gauze. However, if bleeding persists, contact the office
Q) What if I can't go home immediately after surgery?
A) Unfortunately, many patients don’t have a healthy spouse or close family member at home to help them during the initial days and weeks after surgery. For those unable to depend on family or close friends, staying in a skilled nursing facility at the hospital for one to three weeks is occasionally an alternative.
Q) Are there important tips for post-joint replacement surgery?
A) It’s critically important to avoid situations in which you could fall or injure your joint. You may need some assistance for a few weeks, especially while you are regaining your balance, strength, and flexibility. Follow the instructions from your physical therapist regarding regular, light exercise. You will need to take antibiotics prior to dental surgery or any other surgery to prevent bacteria from entering your bloodstream.
Q) When can I return to regular exercise?
A) Most patients who undergo total shoulder replacement are ready to return to exercise and light activities, such as golf, within three to four months after surgery. Follow the instructions from your physical therapist regarding regular, light exercise.
Q) How long will my new shoulder last?
A) Most shoulder replacements can be expected to last 10 to 15 years. If you are overweight or extremely active, your new shoulder’s life span may be shorter.
Expectations for Shoulder Replacement Surgery (Before and After Surgery)
Pre-operative: It will take approximately 45 to 60 minutes to get signatures for surgical consents and to review the instructions regarding your surgery. Be sure to bring a list of current medications, including the drug name, dosage, and the days and times you typically take them.
Pre-admission Appointment: Prior to this appointment—which takes place at the hospital—you should have had your pre-operative tests performed by your family doctor. This appointment will take approximately one to two hours for lab tests, including blood work, EKG, and chest X-ray. If you have a heart or lung condition, or if you are an insulin-dependent diabetic, you must see your family doctor prior to surgery and get medical clearance. Before you leave, you will also meet with someone from the anesthesia department.
Admission: You will be admitted to the hospital the morning of your surgery.
Medications: Stop anti-inflammatory medications and/or aspirin; if you take anticoagulants such as Coumadin, asprin or Lovenox, your surgeon will tell you how long you should cease taking them prior to surgery.
Food and drink: Do not eat or drink anything for eight hours prior to surgery, except for prescribed medications. On the day of surgery, if you do have a prescribed medication to take, swallow it with a small sip of water.
Length of Surgery: The length of surgery is typically two hours followed by another one to two hours in the recovery room.
Length of Hospitalization: Average stay is one to two days.
Anesthesia: Patients will undergo general anesthesia, and may benefit from regional nerve blocks for post-operative pain control.
It is important after surgery to regain full range of motion but to do it with the instruction of trained physical therapists. You will work with a physical therapist each day after surgery to help you retain a full and active range of motion. After you go home from the hospital, you will need physical therapy from three to six times a week for three to six weeks. Before surgery, please consult with our staff to arrange home health services and outpatient physical therapy with Orthopaedic Associates of Central Texas.
IMPORTANT: Prior to surgery, VERIFY INSURANCE BENEFITS FOR YOUR CONTINUOUS PASSIVE MOTION (CPM) AND PHYSICAL THERAPY. THESE ITEMS ARE NOT ALWAYS COVERED BY ALL COMPANIES. IT IS VERY IMPORTANT THAT YOU CONFIRM THE NUMBER OF PHYSICAL THERAPY VISITS APPROVED BY YOUR INSURANCE COMPANY FOLLOWING SURGERY. INFORM YOUR PHYSICAL THERAPY PROVIDER ABOUT WHAT HAS BEEN APPROVED BEFORE YOU BEGIN THERAPY.
Pain management: For the first one to two days after surgery, pain is very well controlled with a PCA (patient controlled anesthesia). It is important to maintain a schedule for the pain medications provided and prescribed. It is best to address the pain before it intensifies. Pain is manageable with medications and will lessen as your surgery heals. Pain medicine can cause itching, nausea, and/or constipation. These are all common side-effects of narcotic-based medications and do not necessarily indicate a drug allergy.
Wound Care: The surgical dressing is usually removed after two or three days. You may keep the incision open to air as long as there is no bleeding or drainage. We will remove your sutures in the office approximately two weeks after your surgery.
Driving: Most patients are able to safely drive a car approximately six weeks after surgery for very short distances only. We recommend that patients do not drive cars with a manual transmission while they are healing because of the sudden and jerky movements that can accompany shifting gears and using the clutch.
Home Care: You will need help with meal preparation for several weeks following discharge from the hospital. We recommend that you have someone stay with you after you leave the hospital for at least a week (and longer if possible). If this is not possible, please let the nurse know you will need assistance after surgery.
Things to Report: Call the office at (512) 244-0766 if you develop any of the following:
- Redness around the incision
- Drainage or bleeding from the incision
- Fever over 101 degrees
- Increased swelling
Return to Work: Following spinal surgery, you will be able to return to sedentary work eight to twelve weeks after surgery. We recommend restricting certain work activities:
- No heavy lifting
- Follow your physical therapist’s instructions about how much range of motion your shoulder can handle as you are healing.
PLEASE NOTE: After shoulder replacement, it will be necessary for you to take antibiotics before you undergo any standard dental work or teeth cleaning. Please contact our office at (512) 244-0766 to arrange for a prescription. If you are on any blood thinners (Coumadin, aspirin) or if you are diabetic, please notify one of the nursing staff members at Orthopaedic Associates of Central Texas