Fixing that Aching Shoulder

A chronic shoulder injury can affect more aspects of your life than you had ever imagined. Gardening, taking care of common household chores, shoveling snow and even driving can aggravate the injury, making your shoulder ache and even making the injury worse. And if you like to take exercise classes, such as yoga or Pilates, the shoulder problem can put a lot of limits on what you're able to do in class.

One of the most common shoulder problems is a rotator cuff injury. The tendons in the shoulder can become inflamed or even tear. This can be caused by wear and tear, aging, a fall on an outstretched arm, a sports accident or other mishaps.

Non-surgical treatments for rotator cuff injury

Conservative treatments for a torn rotator cuff include:

• Rest


• Applications of heat and cold to the area that is sore


• Medication to relieve pain and inflammation


• Electrical stimulation of muscles and nerves


• Cortisone injection


• Exercises that increase flexibility and strength

Sometimes, you can nurse your shoulder ache for a long time, especially if surgery is the last thing you want to think about. But very often, active, healthy people begin to get so frustrated with their limitations that, if conservative treatments aren't effective, they eventually do decide to have an operation.

Sometimes it is possible to perform a surgical repair on the rotator cuff itself. But in many older people, especially those who also have arthritis in the shoulder, a shoulder replacement can offer more success.

New type of shoulder replacement surgery available

The upper bone of your arm (the humerus) ends in the shape of a ball. This ball fits into a socket, which forms your shoulder blade (the scapula). In traditional shoulder replacement surgery, surgeons remove the natural ball and replace it with a metal ball that is supported by a stem. They fit this ball into a new plastic socket that they insert into the shoulder blade. These types of shoulder replacements rely on the rotator cuff muscles and tendons of the shoulder to hold them in place.

But for people whose rotator cuffs no longer function well, a traditional shoulder replacement is not likely to be as effective. A new procedure, called the "reverse" shoulder replacement, which the Food and Drug Administration approved last spring, changes the anatomy of the shoulder. The surgeon places a metal ball into the shoulder blade socket. Then the ball at the top of the arm bone is replaced with a socket that is supported by a metal stem.

When you have the reverse procedure, you learn to move your arm by using your deltoid muscle instead of the rotator cuff. The deltoid is a long muscle that forms the rounded contour of your shoulder.

Who is a good candidate for reverse shoulder replacement?

The best candidates for the reverse procedures are those who:

• Have significant shoulder pain


• Have little to no movement in the shoulder

What are the possible complications?

As with any surgical procedure, complications do exist:

• The arm can become disconnected from the socket


• An infection can develop in the joint

What is the recovery like?

In the first days after the surgery, you will use medication to manage your pain. Most people go home after two days in the hospital. Your arm will be in a sling at first. You will need help at home, because at first, your arm will probably be even less useful than it was before the surgery.

For about six weeks, you are likely to be strictly limited in your arm movement. Your doctor may tell you not to lift anything heavier than a cup of coffee. You will not be able to drive during this time, so you will have to make plans with friends and family members in terms of shopping and doing other errands.

When the strict limitations are lifted, you will begin physical therapy. This is an extremely important part of your recovery. Closely following your physical therapy program, including doing exercises at home, will give you the best chance to regain as much motion as possible in your shoulder.

Most people begin to notice improvement at least by six weeks after the surgery. As your physical therapy continues, you should notice continued improvement. Many people see improvement continue for months and months after the surgery.

The surgery is still new

It is important to remember that reverse shoulder replacement is still relatively new. There has been no opportunity to conduct long-term studies on its success rate. However, it has been used in Europe for about 15 years. Results from those surgeries indicate that 85 to 90 percent of the patients had excellent pain relief.

If you have had rotator cuff problems for a while and feel as though the pain and the limitations on your activity level are more than you want to bear, talk with your doctor about this new procedure.