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Bone & Joint Clinic of Houston
40 Years of Orthopedic practice in the Texas Medical Center
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Bone & Joint Clinic of Houston, For Comprehensive Orthopedic care
Texas Medical Center
The Woodlands | Pearland
Memorial City

T: 713.790.1818
Toll Free: 1.866.226.3773
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Arthroscopic Rotator Cuff Repair

Arthroscopic Rotator Cuff Repair

Rotator Cuff Tears can now be repaired with an all arthroscopic technique using 4 tiny incisions.

Hip and Knee Replacement

Hip and Knee Joint Replacement

Minimal incision and muscle sparing techniques help patients recover more quickly.
Pediatric Orthopedic

Neck and Back Pain

A variety of non-invasive and invasive treatments are available to relieve your back and neck symptoms..
Bone and Joint Articles and Publications

Total Hip Athroplasty

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Shoulder Replacement and Resurfacing and Shoulder Arthritis

SHOULDER ARTHRITIS AND SHOULDER REPLACEMENT AND RESURFACING

Shoulder Arthritis Symptoms and Evaluation


Arthritis is a wearing away of the smooth covering where two bones come together at a joint.  Usually, cartilage is perfectly smooth, like a sheet of ice, and everything glides effortlessly across.  With arthritis, that smooth, perfect cover is worn away and begins to look more like a rough cobblestone street.  As you move your shoulder, those cobblestones grind against each other and cause pain. 

There are two joints within the shoulder.  The glenohumeral joint is where the ball, or humerus, and socket, or glenoid, meet and is enveloped by the muscles of the rotator cuff and the joint capsule.  The acromioclavicular (AC) joint is where the shoulder blade and collarbone meet.  Both can become arthritic.  The pain from glenohumeral arthritis is usually within the depth of the shoulder and it is worse with any movement.  It is usually improved with rest.  Occasionally, people will even feel grinding within the joint when they move their shoulder.  Others will notice weakness or stiffness within the joint.  It is frequently difficult to throw a ball or do any type of heavy activities.  People with arthritis of the glenohumeral joint will frequently have arthritis in other joints and may have already undergone other joint replacement.

You will see one of our orthopedic surgeons who specialize in shoulder arthritis during your visit.  A thorough history of your symptoms and a physical exam focused on your shoulder can be used to make a diagnosis of glenohumeral shoulder arthritis.  X-rays during that same visit can demonstrate a wearing away of the joint space, indicative of arthritis.  A MRI is frequently used additionally to confirm the diagnosis and confirm that your rotator cuff and other structures around your joint are all working normally.

Normal shoulder joint
Normal Shoulder Joint
shoulder arthritis
Shoulder Arthritis
shoulder arthritis 2
Shoulder Arthritis
normal shoulder cartilage
Normal Shoulder Cartilage
shoulder arthritis
Shoulder Arthritis: No Cartilage
 

Shoulder Arthritis Non-Operative Treatment


Similar to the treatment other arthritic joints, all treatment strategies for arthritic shoulders are directed toward alleviating your pain and improving your function.  Initial treatment may include anti-inflammatory arthritis medications or physical therapy to strengthen the muscles around your shoulder and improve the flexibility of your shoulder.  Your physician may also offer you a cortisone injection within the joint itself to relieve your pain.  This combination may very well get you back to all your activities.

Alternatively, some shoulder surgeons have started using an injection series approved for treatment of knee arthritis to help patients with shoulder arthritis.  Joint lubrication medications such as Synvisc, Supartz, or Hyalgan can be injected within the glenohumeral shoulder joint in a series of 3 to 5 shots to try to give long lasting relief for patients with shoulder arthritis.  Ask your physician if this may give you some benefit.

Shoulder Arthroplasty, Shoulder Replacement and Shoulder Resurfacing


When symptoms of glenohumeral arthritis cannot be controlled with non-operative means, your physician may offer a surgical option to help with your symptoms.  Just like knee and hip replacements, shoulder replacements provide a new covering for a worn out joint.  The rough, cobblestone surface is replaced with a smooth, perfectly round metal cap.  Many replacements now can be achieved with a “resurfacing” which allows more of your own bone to be maintained.  These resurfacing implants have been used in Europe for 30 years with great success and have gained recent acceptance here in the United States as well.  Additionally, some people do great with a partial resurfacing if their arthritis is localized to a specific area. 

Normal shoulder joint
Normal Shoulder Joint
Shoulder Arthritis
Shoulder Arthritis
shoulder arthritis
Shoulder Arthritis
shoulder replacement
Shoulder Replacement
shoulder resurfacing
Shoulder Resurfacing

shoulder resurfacing
Shoulder Resurfacing

shoulder replacement
Shoulder Replacement

shoulder resurfacing
Shoulder Resurfacing


This is an “open” operation.  A 3 to 4 inch incision will be made on the front part of your shoulder so that the resurfacing implant can be placed over the humerus.  You will have general anesthesia and be completely asleep for this surgery.  You will likely spend one or two nights in the hospital following this surgery for pain control and intravenous antibiotics.

After the pain initial pain of surgery has gone, you will likely notice that the pain of the arthritis is gone as well.  You will be limited in your activities for the first 6 to 8 weeks as the muscles around your shoulder heal.  Your surgeon will direct your post-operative therapy closely.  Much of your therapy can be completed on your own after a few visits with the physical therapist here or at a location close to your home.  You can expect great pain relief within several weeks after your surgery, and return to most all activities within several months.

Arthroscopic Glenoid Resurfacing


Biologic Glenoid Resurfacing Video

There is an arthroscopic option for young people with shoulder arthritis who do not want a traditional replacement.  The glenoid is the socket of this joint.  It, too, can be worn away.  For some young people, this can be a terrible problem.  Rather than replace the joint or cover it with metal, a patch can be anchored to cover the glenoid socket and provide relief.  This surgery has very limited indications, but for the right person, it can be a lifesaver.

Just as with arthritis in any other joint, first line treatment for arthritic shoulders in young people is directed toward alleviating your pain and improving your function.  Initial treatment may include anti-inflammatory arthritis medications or physical therapy to strengthen the muscles around your shoulder and improve the flexibility of your shoulder.  Your physician may also offer you a cortisone or viscosupplement injection within the joint itself to relieve your pain.  This combination may very well get you back to all your activities.

If your history, exam, x-rays, and MRI all show wearing away and arthritis primarily on the socket part of your shoulder, replacing the cover on that socket may be a good option.  This is a day surgery procedure which goes on here at the hospital or at a nearby outpatient surgical center.  You may spend one night in the hospital for pain control and antibiotics.  You will be seen by an anesthesiologist prior to surgery, who will discuss the option of putting another kind of injection in your shoulder so that your whole arm goes to sleep prior to the surgery and stays asleep for 12 to 24 hours afterwards.  Additionally, you will go to sleep with general anesthesia for the entirety of the surgery.  The surgery takes 1 to 2 hours.  When you wake up, you will have a sling and pillow stabilizing your shoulder.  You will stay in the recovery room until your pain is controlled and you are ready to leave for home or be admitted to the hospital overnight.

During the operation, your surgeon will cover the socket with a patch meant to replace the cartilage which has been worn away from the socket.  The patch is skin obtained from organ donors which has been tested and specially processed for use as a graft.  The patch is anchored down to the bone using stitches.  All of this work is done through several ¼ inch incisions on the front and back of the shoulder.  Even though the patch is the size of a half-dollar coin, it is able to be inserted into the shoulder through a long slender tube after it has been rolled up into the shape of an even smaller tube. 

Those stitches hold the patch down to bone for the next several months while the two grow and heal back together.  It takes several months for that to happen, and that is why your activities will be quite limited during that same time span.  You will do much of your therapy yourself to get your motion and strength back, but you may need some additional help from a physical therapist here or near your home.  You can expect good pain relief within several weeks and return back to more normal activities within 4 to 6 months.
 

Useful Shoulder Arthritis Links

 
 
 
 
 
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