Shoulder osteoarthritis and shoulder prosthesis
What causes shoulder joint destruction?
Several diseases can lead to destruction of the articular surface of the shoulder (osteoarthritis). The most common cause is mechanical wear of protective cartilage that covers the joint surfaces of the glenoid (on the shoulder blade) and humeral head, causing friction of the underlying bone at these extremities, leading over the years to the growth of osseous spurs at the periphery (osteophytes. It occurs primarily in people over 50 years of age and may be primary (without apparent cause), hereditary, associated with rheumatoid arthritis or other rheumatic syndromes, may occur after injury or trauma, resulting from rupture of the rotator cuff or avascular necrosis of the humeral head .
What are the symptoms associated with osteoarthritis?
Patients with this pathology complain of aggravated shoulder pain during activity, with slow onset and progressive aggravation, alleviating with rest. It is located more in the back of the shoulder and can be intensified with weather changes.
It may also manifest with limited mobility and it may be more difficult to raise the arm in activities such as combing hair or reaching a shelf. It can be associated with the swelling and crackling or clicks sounds with shoulder movements.
As the disease progresses any movement of the shoulder causes pain and night pain is common, which can interfere with sleep.
How do I know if I have the condition?
The diagnosis is based on the physical examination and the radiographs that may show narrowing of the joint space and the presence of osteophytes (bone spurs).
Physical examination by the physician may reveal muscle weakness and atrophy, tenderness, decreased mobility, signs of muscle wasting, tendinous or ligamentous lesion, signs of previous injury, involvement of other joints (common in rheumatoid arthritis), and crepitation.
What are the non-surgical treatment options?
Osteoarthritis has no cure but there are some therapeutic modalities available. The non-surgical approach includes the use of anti-inflammatory and analgesic medication and rehabilitation programs. Treatment with chondroprotectors may be attempted, considering the positive response of some patients, but no scientific evidence has been found to attest to the benefit of these supplements.
What is the surgical treatment?
When non-surgical treatment is not effective, surgery may be indicated in shoulders that are severely affected by osteoarthrosis.
In selected cases of mild arthrosis, the surgeon may resort to arthroscopic surgery. It consists of introducing a camera (arthroscope) and appropriate instruments into the interior through small incisions with about 5 to 10 mm. During the procedure the surgeon may debride (clean) the inside of the joint. Although this procedure relieves pain, it will not eliminate or delay the progression of arthrosis, having a temporary effect.
In cases of advanced arthrosis, when non-surgical treatment or arthroscopic surgery did not result in symptom control, shoulder arthroplasty consisting of the replacement of the articular surfaces by artificial components, which constitute the joint prosthesis, is indicated. During the surgery an incision is made on the affected shoulder to expose the joint. The humerus is separated from the glenoid, the joint surfaces are removed and both are replaced by metallic components in the case of total shoulder arthroplasty. The humeral component may or may not have a stem (which follows along the humeral shaft) and can be cemented or uncemented. The glenoid component may be secured with screws. There are two types of prosthesis: anatomical and reverse. The anatomical prostheses mimic the normal conformation of the humeral head and the glenoid and are indicated in situations where the patient maintains an complete and functional rotator cuff. The reverse prostheses present an reverse conformation, in which the convex surface will be applied in the glenoid and the concave in the humerus; It is a prosthesis especially indicated in rotator cuff arthropathy or in situations in which the rotator cuff is irreparably torn or nonfunctional, requiring the deltoid muscle to perform shoulder function.
In some cases hemiarthroplasty, which consists of the replacement of the humeral head only, may be indicated. Although simpler, this procedure is associated with worse long-term results, being reserved for particular situations, namely avascular necrosis in the young and fractures of the proximal humerus in elderly patients with reduced functional capacity.
After placement of the components, the capsule is sutured, as well as the muscle-tendon components and the skin.
Surgery involves some risks: infection, fracture, injury of nerves or vessels, venous thrombosis, irritation of the surgical scar, discrepancy in arm length, wear of the components and aberrant surgical scar.
How I the recovery after arthroplasty (shoulder prosthesis)?
Shoulder arthroplasty is usually very effective in controlling pain. Recovery time and rehabilitation will depend on the type of surgery and the patient.