Arthritis is a painful, inflammatory condition that affects the slick, white cartilage on the ends of bones. As we age, the limited number of cartilage-producing cells declines, and the articular cartilage begins to wear thin. While non-operative treatments such as injections and NSAID’s can effectively treat the symptoms, the only curative treatment is a shoulder arthroplasty.
During this procedure, the physician will replace the arthritic humeral head with a metal ball and the arthritic glenoid with a plastic cup. For a video of this procedure, click this link.
As discussed on our Total Shoulder Arthroplasty page, the hardware used in these cases varies tremendously. Traditional long stem components have recently given way to short stem or completely stemless components like the one shown below from our Fort Sanders West clinic in Knoxville, TN.
As you can see, the bright white “ball” at the end of the humerus (arm bone) does not have a stem extending down the shaft of the humerus. Instead, the component is press-fitted into the softer cancellous bone at the top of the bone. This allows the surgeon to place the component more precisely, as the stem no longer dictates where the prosthesis can be placed.
Also note the thin space between the metal head and the bony “cup” (glenoid). This space is actually filled with a special plastic infused with vitamin E, dramatically increasing the wear characteristics and prolonging the life of the implant. Dr. Spencer worked on the design team for this new cutting edge material, and the results have shown the plastic can last upwards of 20 years. The reason this shows up as clear on x rays is that it is considerably less dense than the surrounding bone.
When implanted correctly and precisely, a total shoulder arthroplasty can make a world of difference regarding pain and function. The procedure essentially replaces the raw, painful bone with painless metal and plastic, allowing most patients to progress through surgery with minimal narcotic use.
Let us know what you think below! We would love to hear your thoughts and field any questions you may have.
Rotator cuff tears are very common. Rotator cuff repairs are the fifth most common surgery performed the United States. Most tears are degenerative and occur with greater frequency in patients over the age of 50. They can, however, occur from traumatic events such as falls or dislocations.
Most rotator cuff tears occur when the tendon or tendons pull away or avulses from the bony attachment at the greater tuberosity. The tear pattern can vary greatly from patient to patient. Most rotator cuff repairs are performed with anchors that are placed into the greater tuberosity. The sutures from those anchors are then passed through the rotator cuff tendons and tied down to the tuberosity bone. This provides very secure fixation. A demonstration of this typical rotator cuff repair can be seen at the bottom of our Rotator Cuff page, here.
The following is a video of an atypical rotator cuff tear where the rotator cuff tendon tore within its mid substance. These types of tears are less common and can be much more difficult to treat as we are not able to use anchors in this situation. However with arthroscopic techniques we are able to achieve a good repair with a very good clinical result.
Posterior instability (instability where the shoulder dislocates or partially dislocates backwards) is not as common as anterior instability were the shoulder dislocates towards the front. Anterior instability is usually secondary to a traumatic event where is posterior instability is frequently associated with repetitive loading. Repetitive loading is common in sports- especially in football lineman.
As opposed to anterior instability, posterior instability is frequently associated with pain and can occur without a true labral tear. It is more commonly associated with laxity in the posterior capsule. In cases where Physical Therapy does not achieve stability, surgical reconstruction of the posterior capsule can be performed.
The following is a case of an arthroscopic posterior capsulorraphy. In this case the posterior capsule and inferior capsule are tightened to treat the laxity and restore stability to the shoulder. These arthroscopic techniques allow the capsule to be tightened with minimal disruption of the surrounding soft tissue envelope.