What is the major cause of the shoulder pain?
Arthritis. Arthritis is the result of the cartilage in a joint being worn out over time. I often describe the arthritis in the shoulder as having a “rusty hinge”. The cartilage in your joint is supposed to be a smooth surface that allows things to move easily; however, when the cartilage wears out as a result of arthritis it becomes a rough surface, or “rusty”. This often results in pain, stiffness, grinding, swelling, loss of motion and loss of function.
How do I know when I’m ready for a shoulder replacement surgery?
If you have pain in your shoulder, limited function and difficulty sleeping it is important to try arthritis medications and cortisone injections. If the medication and injections do not relieve your shoulder pain then it is time to discuss a shoulder replacement.
How old are your shoulder replacement patients?
The typical age group for a shoulder replacement patient is 60-80 years old. I have performed shoulder replacements on patients as old as 90 and as young as the mid- 40s. Every patient’s situation is uniquely different and I take that into consideration when discussing a shoulder replacement.
When should I expect to feel relief from my shoulder pain after my shoulder replacement?
There is some immediate change in regard to the movement of the shoulder being much smoother; however, for a few weeks after surgery it is more painful than before surgery. At about two weeks post-surgery people start to get over the “hump” and it is less painful than prior to surgery. The pain will continue to gradually decrease. Most people by two months post-op are very happy they had their shoulder replaced.
Will I have to stay in the hospital after my shoulder replacement surgery?
Yes. The typical stay is somewhere between 24-48 hours: 50% stay one day while 50% stay two days. Rarely do patients stay longer than two days.
What happens if surgery is not performed?
Rarely will the condition improve without surgery. Most often, the pain increases and the movement and strength decrease. Fortunately, this occurs slowly over the years.
Are any other options available?
While I believe that surgery is the best course of action, there are other available treatments including no treatment, just living with the condition; physical therapy exercises; medication or injections. Any of these treatment options may be successful in your situation, and some of these you may have already tried. In my experience, they will not work reliably if they haven’t worked already. Of course, we can arrange for any or all of these options if you desire.
What brand of replacement will we be using?
I prefer the DJO Surgical AltiVate Shoulder System. While there are several good replacement equipment options; DJO Surgical is what I have the most experience with and observed the best outcomes with.
I’ve heard there is a shoulder replacement that you put in backwards?
It is called a Reverse Shoulder Replacement. It is not better or worse than a standard (anatomic) shoulder replacement, it is just necessary in certain circumstances. The circumstances we use it in are when you have a non-functional rotator cuff or a complicated fracture. Based on your examination and imaging, we will plan for either a standard or reverse shoulder replacement.
What is the replacement made of?
The replacement is made of titanium, stainless steel and high-density plastic in the socket. I have an example of the replacement I can show you when you come for an office visit. An allergy test is not needed. In my experience, I have never seen allergies to the metal in any of my patients.
How long will my shoulder replacement last?
The estimate is around 15-20 years, but that estimate is variable and we see them last longer in some patients. It is difficult to predict how long each patient’s shoulder replacement will last, specifically because the materials we use now are improved from those 7-8 years ago.
Typically, if you need a shoulder redone, you redo the whole thing (not just parts), but it is rare that we have to do that. For most people, the initial shoulder replacement will last them for as long as they need it and will does need to be redone.
What kind of anesthesia is used?
We use general anesthesia because we cannot do this type of surgery with local anesthesia. General anesthesia is currently the only reliable method that allows us to work deep inside your shoulder.
In addition, you may receive a nerve block. The anesthesiologist will numb up the shoulder before surgery. This lasts 12-24 hours, and helps decrease pain after surgery. ice, and rest to help control the pain. Regaining range of motion takes time, patience and persistence… it only improves at a certain rate each month.
What will I feel when I wake up?
Following surgery, you will awaken in the recovery room with your arm in a sling. Nothing can eliminate the pain completely. Medication, the sling and rest will control it so that you will be as comfortable as possible.
Is ice or heat helpful after surgery?
Ice is recommended instead of heat. An ice pack should be applied to the shoulder (not directly on the skin) for at least 20 minutes, three times a day.
The use of a cold therapy device (e.g. PolarCare) device helps decrease pain and swelling after surgery. The use of the device may or may not be covered by the particular health insurance plan you have selected. You should check with your insurance company. It is optional to use. A cold-therapy device can also be purchased for you to own. Please contact us if you would like to purchase one.
Will I need to wear a brace?
A sling and pillow is all that you will use. Patients wear the sling for 4 to 6 weeks but remove it for bathing and dressing. Use of the sling is important to maximize healing.
What about complications?
Shoulder surgery is a complex and delicate process designed to repair damaged structures deep within the human body. Complications can occur. Fortunately, these are rare.
Infection is the number one concern. We take a lot of precaution to prevent an infection when it comes to the surgery technique and antibiotics (you get antibiotics around the time of surgery). From a practical standpoint, wearing out of the parts over time can cause complications. Additionally, wound problems including swelling, bleeding, delayed healing, unsightly or painful scar. Bone infection or fracture could very rarely occur. Joint problems including stiffness could occur. Failure to achieve the desired result is not strictly a complication but it can be a source of disappointment. This operation may result in incomplete motion, strength or function. Nerve injury is extremely rare but may result in temporary or permanent, partial or complete loss of feeling and/or movement in the arm. My purpose in listing the types of complications that could possibly occur is to inform, not frighten you. While it would be preferable if we could perform surgery without any risk, this is not the case. The complications are rare (less than 1%) but regrettably, in spite of our best efforts, they do occur. I feel it is your right to know.
How successful is the surgery?
This type of surgery is successful about 85-95% of the time. No shoulder operation is 100% successful in every individual but the procedures we perform are reliable and will help restore the potential function in your shoulder. The operation is most successful at relieving pain. What is harder to accomplish is the return to vigorous overhead use of the arm in work and/or sports. Whether you can return to your previous level is an individual matter and depends on the damage to your shoulder, how well it heals, how well you rehabilitate and how strenuous is your desired level of work or sports. Because of the many variables involved, I can make no guarantees other than to assure you I will deliver the very best medical care possible.
When can I return to routine activities?
You will be able to use your fingers, wrist and elbow immediately after surgery. You may walk with assistance as soon as you have recovered sufficiently from anesthesia. If you live alone it may be helpful to have someone stay with you for 1-2 days. You may shower or bathe with regular soap and water 48 hours after surgery. Bend from the waist and let your operated arm move away from your side; then use your good arm to wash under your armpit. Some patients find it helpful to put a plastic stool or chair in the shower for a day or two.
Remember that you are doing everything with one hand. You may walk outdoors, write, cook, and drive a car (automatic shift) within a few days. Connecting the seat belt is awkward. Take your time and move slowly. Do not lift more than 1-2 pounds with your operated arm.
When can I return to work?
For most office jobs, I recommend taking a week off work. This will allow you to devote time to your therapy exercises. Some people are able to return to work sooner. When you return to work your arm will be in a sling (for 4 to 6 weeks after surgery), but you should be able to manage as long as you do no lifting, pushing, pulling or carrying with the operated arm.
Of course, instructions in the proper use of your arm will be given to you before you leave the hospital.
You may begin light duty work involving no lifting, pushing, pulling or carrying, within ten days after surgery. Return to heavy lifting or overhead use may require 6 months or more. There are no fixed rules for return to work. What I have described above are reasonable guidelines that I hope will help you and your employer ease your return to the workplace. Full recovery takes about one year.
How is the shoulder rehabilitated?
The recovery after shoulder replacement surgery is complicated, and requires a delicate balance between allowing the shoulder to heal without letting it get too stiff. I have designed recovery protocols based on the latest medical research. There are certain restrictions to be mindful of, and phases of therapy outlined in the protocol. Because of the complexity of the recovery, I recommend you work with a physical therapist. We will discuss when to start physical therapy at your first post-operative visit (10-14 days after surgery).
What about sleeping?
Most of our patients feel more comfortable sleeping in an upright position. Many use a “Lazy-Boy” type recliner. You may purchase one at most furniture stores. If you want to use the chair for 1-2 months after surgery you may consider a rental. It can take a few months after surgery before the pain at night completely goes away.
When do you return to the office?
Your first office visit is 10 to 14 days after surgery so that either Sarah or myself can examine the surgical incision and review your recovery with you. We will give you additional instructions for physical therapy and refill pain medications as needed. Two months after surgery we will advance your activities. Office visits then occur at 4 months, 6 months, and 1 year after surgery. Additional office visits may be required. There is no charge for office visits the first 90 days after surgery.
What about pain medicine?
Your pain medication prescription will be given to you the day of surgery. Because of Texas laws and regulations, a written script must be given as we cannot call in narcotic pain medication. Please take your pain medication as directed. That means that you may take the pills every 3-4 hours as needed. Take the medicine with food in your stomach. Taking the medicine on an empty stomach can cause nausea. You do not have to take the pills if simple rest, arm repositioning or ice helps control your pain. Everyone responds to pain and surgery differently. If you need more medication, please call us or let us know at your office visit. Because narcotic pain medication must be prescribed in writing, allow us 1-2 business days to complete the process before you run out of pain medication. We cannot do this after 5:00 PM, as no one will be in the office. We cannot refill narcotic medication on weekends. One of my colleagues at the Fondren Orthopedic Group is available 24 hours a day, 7 days a week but we ask that you restrict after hours and weekend calls to emergencies only and let us handle less urgent problems during the week.
How much does the surgery cost?
Since insurance coverage is a complicated business with no fixed rules, please check with your insurance carrier in regard to the specifics of your proposed shoulder surgery. Also note that the hospital bill is not something that I can control, so please direct any questions regarding the specifics of the hospital, x-ray, laboratory and anesthesia bill to the hospital billing office.
Shoulder operations such as this are complex and require a trained surgical team. I work with another fully trained assistant or physician who assists me during the operation. You may receive a bill for his or her services.
Why all the questions about my health?
Although the operation involves your shoulder, your entire body will react to the anesthesia and surgery. Your general medical condition is obviously important. Before surgery you must see the anesthesiologist. They will go over your medical condition and request any tests (blood tests or EKGs) or consultations with other physicians if necessary.
What should I do before surgery to prepare?
It is a good idea to practice doing some activities with one hand. Imagine that your operated arm is in a sling. Practice getting dressed, going to the bathroom, combing your hair, using a hair dryer and driving a car. Can you get out of the car, close the door and get a parking ticket with your arm in a sling? My patients who drive trucks have found it helpful to have a small stool so they don’t have to reach up and enter the cab.
What if I have more questions?
We encourage you to return to the office for a further discussion at any time. We will do our best to answer any questions by phone or email (firstname.lastname@example.org) as well. We have a lot of information on our website, www.gomberamd.com. There are surgical animations on the website as well.
When is surgery performed?
I perform surgery on Mondays and Fridays at Texas Orthopedic Hospital.
How do you schedule surgery?
Contact Chantel at (713) 794-3457 or email@example.com