Shoulder
Arthropathy
Shoulder pain is a commonly affects middle aged and elderly and could be due to many causes. Shoulder pain should be differentiated from neck pain radiating to shoulder and referred pain from other parts of body like gall bladder or heart.
The typical shoulder pain is felt only upto elbow (does not cross to forearm) and is typically worse on lying on the same shoulder and with overhead activities.
Arthropathy Causes
The Shoulder is a ball and socket joint, covered by capsule and ligaments that provide stability. The ball is surrounded by a group of 4 muscle- tendons, collectively called the Rotator cuff. The cuff stabilizes the shoulder, rotates the arm and raises the arm. The cuff tendons lie under a bone called acromion, separated by lubricating sac – bursa
Shoulder pain arises, when these tendons are torn, abnormally rub against the bone ( impingement) or if the lubricating bursa is inflamed (bursitis). The capsule itself can get inflamed and contracted producing a stiff & painful condition called frozen shoulder. The moving surfaces of the joints get eroded with age or injury resulting in arthritis. The collar bone joint (AC joint) can result in pain when its become worn out. Pain could also come from calcific depositis in the tendon, irritation of the biceps tendon among other causes.
End Stage Cuff Arthritis
Neglected tears get retracted and the stabilising effect of the cuff tendons is lost. The numerus is poorly controlled and starts migrating upwards and hitting against the collar bone. This results in erosion of cartilage and damage to bone. This painful degenerative condition is called cuff arthropathy (arthritis).
Symptoms :
Pain worsens with time
Night Pain
Weakness
Activities become very painful
Reverse Shoulder Replacement
Chronic tears are characterised by loss of function and severe pain. Shoulder arthroplasty (joint replacement) solves both these problems. Once the stabilising effect of tendons is lost, the deltoid muscle cannot lift the shoulder. The fulcrum of this function has to be reestablished. This is accomplished by a shoulder replacement technique called “Reverse shoulder” in which the the ball and socket position are reversed. The ball, now attached to the original socket re-establishes the fulcrum, which allows the deltoid to lift the arm. This procedure also gives pain relief in addition.
Arthritis
Shoulder can also undergo general wear and tear due to age and overuse. It is much less common than arthritis occuring in knee or hips. Shoulder can also get affected by rheumatoid arthritis. The definitive treatment for arthritis is a total shoulder, if the cuff function is good. In elderly with suspicious cuff function ( above 70 yrs) a reverse shoulder is preferred.
Total Shoulder Arthroplasty
In this procedure, the head is replaced with a metallic ball with a stem, which is fixed in the humeral stem. The worn out socket is resurfaced with a metal backed polyethylene insert. This procedure gives pain relief and functional improvement in advanced arthritis.