Treatment Options Treatment Options for Shoulder Painfor Shoulder Pain

Anatomy of the ShoulderAnatomy of the Shoulder

Made up of 3 bones:Made up of 3 bones: Scapula (shoulder Scapula (shoulder

blade)blade) Humerus (upper Humerus (upper

arm bone) arm bone) Clavicle Clavicle

(collarbone) (collarbone)

(Collarbone)

(Shoulder Blade)(Upper arm

bone)

Shoulder FactsShoulder Facts Most complex Most complex

joint in the body.joint in the body. One of the few One of the few

joints with 360 joints with 360 degrees rotation.degrees rotation.

Extensive array Extensive array of ligaments and of ligaments and muscles.muscles.

Shoulder JointShoulder Joint

Healthy Healthy shoulder jointshoulder joint

Arthritic Arthritic shoulder jointshoulder joint

Causes of Shoulder PainCauses of Shoulder Pain

Osteoarthritis (wear Osteoarthritis (wear and tear)and tear)

Rheumatoid arthritisRheumatoid arthritis Rotator cuff tearsRotator cuff tears Shoulder Shoulder

impingement (bursitis impingement (bursitis and tendonitis)and tendonitis)

Repeated dislocations Repeated dislocations or fracturesor fractures

TraumaTrauma

Symptoms of Shoulder ArthritisSymptoms of Shoulder Arthritis Pain:Pain:

Centered in the back of shoulder if Centered in the back of shoulder if glenohumeral shoulder joint is affected.glenohumeral shoulder joint is affected.

Focused on the front of the joint if AC joint Focused on the front of the joint if AC joint is affected.is affected.

Rheumatoid arthritis will affect both of Rheumatoid arthritis will affect both of these areas.these areas.

Reduced/Loss of range of motionReduced/Loss of range of motion Grinding or catching sensation Grinding or catching sensation StiffnessStiffness

Preparing for ExaminationPreparing for Examination

Have the following information Have the following information ready for your exam:ready for your exam: Chief complaint (Where it is hurting Chief complaint (Where it is hurting

the most?)the most?) Chronology of illnessChronology of illness What effect does the pain have on What effect does the pain have on

your life?your life? Family historyFamily history

Diagnosing Shoulder ArthritisDiagnosing Shoulder Arthritis

Physical examinationPhysical examination Medical history reviewMedical history review Strength and Motion testStrength and Motion test X-RaysX-Rays ArthrogramArthrogram Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI) Blood testsBlood tests

Blood CountBlood Count Rheumatoid Factor for rheumatoid arthritisRheumatoid Factor for rheumatoid arthritis C-Reactive ProteinC-Reactive Protein

How Can My Life ChangeHow Can My Life Change with Treatment? with Treatment?

A return to mobility.A return to mobility. Regaining a sense of Regaining a sense of

your former lifestyle.your former lifestyle. A change in your pain A change in your pain

symptomssymptoms

Non-surgical Treatment Options for Non-surgical Treatment Options for Shoulder Pain: Shoulder Pain:

Over-the-Counter MedicationsOver-the-Counter Medications Nonsteroidal Anti-Inflammatory Drugs Nonsteroidal Anti-Inflammatory Drugs

(NSAIDS)(NSAIDS) Usually first drug used to treat arthritisUsually first drug used to treat arthritis Can reduce pain, swelling and rednessCan reduce pain, swelling and redness Relief can take several monthsRelief can take several months Examples:Examples:

ibuprofen (ibuprofen (Advil®, Motrin®)Advil®, Motrin®) naproxen (naproxen (Aleve®)Aleve®)

AspirinAspirin Reduce joint pain and inflammationReduce joint pain and inflammation Form of NSAIDsForm of NSAIDs

Non-surgical Treatment Options for Non-surgical Treatment Options for Shoulder Pain: Over-the-Counter Shoulder Pain: Over-the-Counter

MedicationsMedicationsAcetaminophenAcetaminophen

Reduces painReduces pain Lowers feverLowers fever Does not reduce inflammation of Does not reduce inflammation of

arthritisarthritis Examples:Examples:

Tylenol®Tylenol® Datril® Extra StrengthDatril® Extra Strength Tempra®Tempra®

Non-Surgical Treatment Options for Non-Surgical Treatment Options for Shoulder Pain: Prescription Shoulder Pain: Prescription

MedicationsMedications NSAIDS NSAIDS

Most popular type for osteoarthritis treatmentMost popular type for osteoarthritis treatment Includes ibuprofen (Includes ibuprofen (MotrinMotrin®®), ), naproxen sodium naproxen sodium

((AnaproxAnaprox®®)), oxaprozin , oxaprozin (Daypro(Daypro®®)), sulindac , sulindac (Clinoril(Clinoril®®) ) , etc. , etc.

AnalgesicsAnalgesics Provide pain relief, but do not reduce Provide pain relief, but do not reduce

inflammationinflammation Includes Acetaminophen with codeine (TylenolIncludes Acetaminophen with codeine (Tylenol®®

with Codeine), Oxycodone (OxyContinwith Codeine), Oxycodone (OxyContin®®, , RoxicodoneRoxicodone®®), Hydrocodone with acetaminophen ), Hydrocodone with acetaminophen (Vicodin(Vicodin®®, Dolacet, Dolacet®®), etc.), etc.

Non-surgical Treatment Options for Non-surgical Treatment Options for Shoulder Pain: Prescription Shoulder Pain: Prescription

MedicationsMedications Biological response modifiersBiological response modifiers

Treat rheumatoid arthritis; may postpone injury to the jointsTreat rheumatoid arthritis; may postpone injury to the joints Includes: Infliximab (Includes: Infliximab (RemicadeRemicade®®), Etanercept (Enbrel ), Etanercept (Enbrel ®®))

Glucocorticoids or corticosteroidsGlucocorticoids or corticosteroids Treat rheumatoid arthritis; fight inflammationTreat rheumatoid arthritis; fight inflammation Includes: cortisone, hydrocortisone (CortefIncludes: cortisone, hydrocortisone (Cortef®®, Hydrocortone, Hydrocortone®®), ),

Prednisolone (PrelonePrednisolone (Prelone®®) ) DMARDSDMARDS

Treat rheumatoid arthritis; slow joint destructionTreat rheumatoid arthritis; slow joint destruction Includes: methotrexate, injectable gold, penicillamine (DepenIncludes: methotrexate, injectable gold, penicillamine (Depen®®), ),

Azathioprine (ImuranAzathioprine (Imuran®®), etc.), etc.

Non-surgical Treatment Non-surgical Treatment Options for Shoulder PainOptions for Shoulder Pain

Cortisone injectionsCortisone injections Powerful anti-inflammatory medicationPowerful anti-inflammatory medication Temporary pain relief lasting several Temporary pain relief lasting several

weeks to monthsweeks to months Small risk of infectionSmall risk of infection

Activity modificationActivity modification Assistive devices, such as reachers Assistive devices, such as reachers Physical therapyPhysical therapy

Surgical Options for Shoulder Surgical Options for Shoulder PainPain

SynovectomySynovectomy ArthroscopyArthroscopy Soft tissue repairSoft tissue repair Shoulder replacement surgeryShoulder replacement surgery

Reverse shoulder replacementReverse shoulder replacement HemiarthroplastyHemiarthroplasty Total shoulder replacementTotal shoulder replacement

SynovectomySynovectomy

Early stages of rheumatoid Early stages of rheumatoid arthritis.arthritis.

Removes inflamed tissue lining.Removes inflamed tissue lining. Potentially saves joint from Potentially saves joint from

further damage.further damage.

Synovectomy, continuedSynovectomy, continued

Small incision is made.Small incision is made. Arthroscope is used to inspect the Arthroscope is used to inspect the

joint.joint. Diseased synovium is removed.Diseased synovium is removed. Sling may be required.Sling may be required. Physical therapy usually required.Physical therapy usually required.

Synovectomy, continuedSynovectomy, continued

BenefitsBenefits Alleviates rheumatoid arthritis pain in the Alleviates rheumatoid arthritis pain in the

jointjoint Joint may be saved from further damageJoint may be saved from further damage Synovium could grow back over timeSynovium could grow back over time

DisadvantagesDisadvantages Not a permanent solutionNot a permanent solution

Arthroscopic SurgeryArthroscopic Surgery Used when osteoarthritis causes Used when osteoarthritis causes

small pieces of cartilage to wear small pieces of cartilage to wear away from joint and float around.away from joint and float around.

Removes any debris and smoothes Removes any debris and smoothes cartilage surfaces.cartilage surfaces.

Potentially saves joint from further Potentially saves joint from further damage.damage.

Arthroscopic SurgeryArthroscopic Surgery

A small camera is inserted into the A small camera is inserted into the shoulder through small incisions, shoulder through small incisions, allowing the doctor to see inside the allowing the doctor to see inside the joint.joint.

Arthroscopic SurgeryArthroscopic SurgeryBenefitsBenefits

Less invasive option may lead to shorter Less invasive option may lead to shorter recovery timerecovery time

Smaller incisionsSmaller incisions Can be performed on an outpatient basisCan be performed on an outpatient basis

Risks (common to all surgeries)Risks (common to all surgeries) InfectionInfection Excessive bleeding or swellingExcessive bleeding or swelling Formation of blood clotsFormation of blood clots Damage to adjacent tissueDamage to adjacent tissue

Soft Tissue RepairSoft Tissue Repair

Tissue patch used to reinforce Tissue patch used to reinforce rotator cuff repair.rotator cuff repair.

Fixes over an area of weakened or Fixes over an area of weakened or damaged soft tissue.damaged soft tissue.

Provides a framework for new Provides a framework for new tissue to grow.tissue to grow.

Gradually the patch disappears Gradually the patch disappears until only your own tissue remains.until only your own tissue remains.

Soft Tissue Repair, continuedSoft Tissue Repair, continued

BenefitsBenefits Adds strength and durability to tissueAdds strength and durability to tissue Less-invasiveLess-invasive

Risks (common to all soft tissue repairs)Risks (common to all soft tissue repairs) InfectionInfection InstabilityInstability Increased stiffnessIncreased stiffness AdhesionsAdhesions

When is Shoulder Replacement When is Shoulder Replacement Surgery Right for You?Surgery Right for You?

Experience significant pain. Experience significant pain. Reduced or loss of function Reduced or loss of function

despite non-surgical despite non-surgical treatments.treatments.

Quality of life has significantly Quality of life has significantly changed.changed.

Medications for pain are no Medications for pain are no longer effective.longer effective.

Total Shoulder ReplacementTotal Shoulder Replacement There are over 16,000 There are over 16,000

shoulder replacements shoulder replacements each year.each year.11

Surgeon will decide the Surgeon will decide the type of shoulder type of shoulder replacement.replacement.

Choice is based on age, Choice is based on age, lifestyle and the surgeon’s lifestyle and the surgeon’s experience. experience.

1. www.jointreplacement.com1. www.jointreplacement.com

Shoulder Replacement Shoulder Replacement ComponentsComponents

The metal humeral The metal humeral component replaces component replaces the ball on the top of the ball on the top of the stem and fits the stem and fits into the upper arm into the upper arm bone.bone.

The plastic glenoid The plastic glenoid component replaces component replaces the socket of the the socket of the shoulder.shoulder.

Shoulder ReplacementShoulder Replacement

Depending on the damage, the Depending on the damage, the surgeon may replace:surgeon may replace: Only the humeral head Only the humeral head

(hemiarthroplasty)(hemiarthroplasty) Both the humeral head and glenoid Both the humeral head and glenoid

Reverse Shoulder Reverse Shoulder ReplacementReplacement

Designed for end-stage cuff tear Designed for end-stage cuff tear arthropathy sufferersarthropathy sufferers

Extreme shoulder degeneration; Extreme shoulder degeneration; cannot function normallycannot function normally

May improve motion and stability May improve motion and stability by changing shoulder mechanicsby changing shoulder mechanics

Reverse Shoulder Reverse Shoulder Replacement, continuedReplacement, continued

Because the shoulder mechanics Because the shoulder mechanics have been reversed, the stronger have been reversed, the stronger muscles can now lift the arm. muscles can now lift the arm.

Reverse Shoulder Reverse Shoulder Replacement CandidatesReplacement Candidates

Recommended for patients:Recommended for patients: Age 70 years or olderAge 70 years or older Experience significant painExperience significant pain Have little to no movement in their Have little to no movement in their

shoulder shoulder Not Recommended for patients:Not Recommended for patients:

With bone disease, deficiencies in the With bone disease, deficiencies in the scapula or non-functioning deltoid scapula or non-functioning deltoid musclesmuscles

Younger or physically activeYounger or physically active

Potential Benefits to Patients Potential Benefits to Patients from Surgeryfrom Surgery

Return to mobilityReturn to mobility Restore their lifestyleRestore their lifestyle FreedomFreedom

Individual results may vary. There are potential risks and recovery can take time. The performance of any new joint will depend on your weight, activity level, age and other factors.

Surgical ProcedureSurgical Procedure

Patient is anesthetized. Patient is anesthetized. Incision is made on the shoulder.Incision is made on the shoulder. The ball portion of the humeral The ball portion of the humeral

head is removed.head is removed.

Surgical Procedure, continuedSurgical Procedure, continued

The humeral and glenoid implant The humeral and glenoid implant components are inserted.components are inserted.

Incision is closed.Incision is closed. A shoulder splint or immobilizer A shoulder splint or immobilizer

may be worn after surgery.may be worn after surgery.

Preparing for Joint Preparing for Joint Replacement SurgeryReplacement Surgery

Ease anxiety by mentally preparing with:Ease anxiety by mentally preparing with: Breathing exercises Breathing exercises MeditationMeditation ImageryImagery Talking with friends and familyTalking with friends and family

Learn more about shoulder replacement Learn more about shoulder replacement surgery:surgery: BrochuresBrochures HandoutsHandouts WebsitesWebsites VideosVideos

The Night Before SurgeryThe Night Before Surgery

Avoid medications, such as “blood Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.). thinners” (aspirin, ibuprofen, etc.).

Do not consume any food or liquid Do not consume any food or liquid after midnight.after midnight.

Make sure you have everything Make sure you have everything you’ll need at the hospital.you’ll need at the hospital.

Ask any questions you may have Ask any questions you may have before surgery.before surgery.

After SurgeryAfter Surgery

Switch to a pain medicine taken by Switch to a pain medicine taken by mouth after a day or so.mouth after a day or so.

Gentle basic range-of-motion Gentle basic range-of-motion exercises begin after leaving exercises begin after leaving recovery room.recovery room.

Two in-patient treatments per day Two in-patient treatments per day while in hospital.while in hospital.

Hospital DischargeHospital Discharge

You will be released from the hospital as You will be released from the hospital as soon as:soon as: The incision is dry.The incision is dry. Comfortable taking only oral pain medication.Comfortable taking only oral pain medication. Able to perform the range of motion Able to perform the range of motion

exercises.exercises. Home support system is in place.Home support system is in place.

Average recovery period lasts three to six Average recovery period lasts three to six months.months.

A Caregiver’s RoleA Caregiver’s Role

Provide support and show patienceProvide support and show patience Help with needs that the patient Help with needs that the patient

can not do, like:can not do, like: Meal preparationMeal preparation Grocery shoppingGrocery shopping LaundryLaundry Driving to medical appointmentsDriving to medical appointments

Physical Therapy After SurgeryPhysical Therapy After Surgery

Begins one day after surgery.Begins one day after surgery. Starts with information gathering Starts with information gathering

about day-to-day problems, testing about day-to-day problems, testing strength, range of motion, strength, range of motion, palpation, etc. palpation, etc.

Develop a treatment plan.Develop a treatment plan.

Recovery in the First WeekRecovery in the First Week

Expect personal limitations on Expect personal limitations on activities.activities.

Important to limit any sudden or Important to limit any sudden or stressful movements to your stressful movements to your shoulder.shoulder.

May be required to wear a sling or May be required to wear a sling or protective device for at least a protective device for at least a month after surgery.month after surgery.

Recovery in the First MonthRecovery in the First Month

Stitches are removed seven to 10 Stitches are removed seven to 10 days after surgery.days after surgery.

A formal physical therapy program A formal physical therapy program begins 10 to 14 days after surgery.begins 10 to 14 days after surgery.

Shoulder should continually Shoulder should continually improve up to six months after improve up to six months after surgery.surgery.

Recovery After Six WeeksRecovery After Six Weeks

Ability to return to work will Ability to return to work will depend on progress and type of depend on progress and type of work.work.

Driving should wait until you can Driving should wait until you can perform the necessary functions perform the necessary functions comfortably.comfortably.

No contact sports or any heavy No contact sports or any heavy lifting for at least six months.lifting for at least six months.

Questions?Questions?

Thank you!Thank you!