Shoulder Pain
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The shoulder is a complex joint with multiple different things that can cause pain. Depending on your age, various shoulder ailments have other treatments. When our group looks at a shoulder, we use age, x-ray, physical, and sometimes MRI to guide treatment. Typically, those under 50 rarely have arthritis and tend to have more sports injury -related problems like labral tears and SLAP tears. Between 40 and 70, we see more issues with bursitis and rotator cuff injury as well as patients with early arthritis. Over the age of 70, we will typically see chronic rotator cuff tears with arthritis. As you can see, shoulders have a wide variety. Please refer to our other pages for Rotator Cuff Tear page, SLAP Tears page, or our Labral Tears and Shoulder Dislocation pages for more information on other shoulder problems.
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Shoulder pain can be debilitating
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Conservative Management
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Management of shoulder pain is dependent on what your physical exam and imaging (X-Ray, MRI) show. Our goal is always to avoid surgical intervention if possible, and we always start with conservative management. Conservative management includes steroid injections and physical therapy. Many patients can tolerate shoulder problems longer than equivalent problems in the knee or hip because the shoulder is a non-weight bearing joint- you do not walk on your arms! Therefore, the shoulder is more resilient to lower grades of arthritis and therefore conservative management is extremely effective. Once a diagnosis is obtained, we will tailor your physical therapy to the specific condition you have. For some exercises to try at home, visit our page on Home Therapy.
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Passive motion assistance with a physical therapist.
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Shoulder Arthritis
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The shoulder is composed of a ball (humeral head) and a socket (glenoid). These two surfaces have very wide ranges of motion and are integral to using our arms. Shoulder arthritis is far less common than hip or knee arthritis, and since we don't walk on our shoulders, we tend to notice shoulder arthritis when it is further advanced to comparable arthritic level in the knee or hip. Shoulder arthritis most commonly presents with an inability to rotate the arm externally. See diagram letter A to see how normal shoulder rotates 90*. In shoulder arthritis, we can limit external rotation to less than 30*, depending on severity. Other signs and symptoms include grinding, clicking, popping, and inability to lift the arm.
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How to measure shoulder range of motion.
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What is wrong with my shoulder?
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This is probably the most challenging question to answer in an online format. A physical exam is an excellent way to test the range of motion, function and compare it to an X-Ray to identify what the problem may be. Shoulder conditions, as we age, tend to be due to more than one specific issue. 10-20% of all patients with shoulder arthritis will have rotator cuff tears. Patients over 70 with arthritis tend to have severe arthritis and a much higher rotator cuff tears rate. We will break down individual problems of the shoulder and how they are addressing.
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Shoulder arthritis which will likely cause severe shoulder pain.
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Partial Shoulder Replacement (Resurfacing Hemiarthroplasty)
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Depending on how old you are, if you have arthritis of only the humeral head (ball), there is a specific procedure called a hemiarthroplasty or "cap" where we only replace the ball. As this is a relatively easy resurfacing procedure, patients return to function extremely quickly. Pain is minimal, and return to prior functional levels is excellent. This procedure is typically performed in patients 45-60 who only have arthritis of the joint's ball component.
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Partial shoulder replacement replacing only the humeral head (ball) also know as shoulder resurfacing.
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Total Shoulder Replacement
Total shoulder replacement is classically done for patients 50 and older for the ball and the socket's arthritis. The rotator cuff must be intact or reparable in order to have this procedure upon placement of the shoulder implants, they most closely resemble normal shoulder anatomy. Patients with total shoulder replacements typically have excellent results and regain nearly full range of motion. Shoulder replacement is highly successful. Patients can look for smaller incisions with cutting edge design implants when you have a shoulder replacement with Atlanta Bone and Joint.
We trialed much of the technology in the knee and hip, where much more research has classically been done due to significantly more joint replacements of the hip and knee. However, as our population ages and grows, the amount of shoulder replacements continues to increase, and therefore, much more dedication to shoulder replacement surgery is being done. Our doctors, who have been at the forefront of hip and knee technology, have helped companies translate our hip and knee technology to the shoulder.
We trialed much of the technology in the knee and hip, where much more research has classically been done due to significantly more joint replacements of the hip and knee. However, as our population ages and grows, the amount of shoulder replacements continues to increase, and therefore, much more dedication to shoulder replacement surgery is being done. Our doctors, who have been at the forefront of hip and knee technology, have helped companies translate our hip and knee technology to the shoulder.
Replacing the ball (humeral head) and the socket (glenoid) is known as a total shoulder replacement
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Reverse Total Shoulder Replacement
The final group of shoulder arthritis are our patients over the age of 60 with irreparable rotator cuff tears. Typically these patients will have had a prior rotator cuff repair and have had progressive arthritis with a steady decrease in function. This patient can typically not lift their arm and have debilitating arthritis. There was no real procedure to be performed for this group of patients with massive rotator cuff tears in the past. However, a new design in the early 2000s was done and made it, so the rotator cuff was no longer needed to ensure a safe shoulder replacement. By changing the kinematics by reversing the ball and socket, we have been restored motion to thousands that once were told there was nothing left that could be done.
A reverse total shoulder replacement. Notice how the glenoid (socket) has become round and the humeral head (ball) has become dished. We reverse the ball and socket.
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What is the difference between a Total Shoulder Replacement compared to a Reverse Total Shoulder Replacement?
On the left a primary total shoulder replacement while on the right a reverse total shoulder replacement. Notice how the ball and socket have been "reversed."
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