Medically Reviewed by Patrick K. Denton, MD

Wear-and-tear or injury can lead to a bad shoulder and the need for treatment. McLeod Orthopedic Specialist Dr. Patrick Denton explains the treatment and possible shoulder joint replacement.

Here’s a summary of Dr. Denton’s explanation:
The most common causes for shoulder replacement are:

• Osteoarthritis, which is the wear and tear arthritis of the smooth cartilage in the joint. 
• Rheumatoid arthritis, which is an inflammatory arthritis where the body attacks itself.
• It could be after a significant trauma or injury to the shoulder. You’re more prone to develop post-traumatic arthritis.
• Patients can have chronic rotator cuff tears that weren’t addressed or fixed and have progressed to osteoarthritis.

The most common symptoms associated with shoulder osteoarthritis are pain in the shoulder, often at night. Patients say it is worse at the end of the day or when they are trying to rest or lay down at night. Most often, the pain is on the side of the shoulder but can also sit behind the shoulder. Patients will say that they also have difficulty with pain and discomfort trying to raise their arm overhead or trying to lift heavy objects. Another common symptom of shoulder osteoarthritis is limited range of motion of the shoulder. As shoulder arthritis progresses, the shoulder becomes stiffer. Patients have more difficulty with overhead lifting or reaching above their waist level. Often, it’s also associated with pain.

The most common nonsurgical treatment for shoulder osteoarthritis includes physical therapy, anti-inflammatory or anti-arthritis medicines and injections. We will try to maximize and prevent surgery as long as we can. Yet, if the conservative measures don’t work, it’s time to proceed with a shoulder joint replacement.

The shoulder is a ball and socket joint. The ball and the socket rub on each other. Smooth cartilage allows them to slide smoothly. In patients that need shoulder replacement, the cartilage is worn and they have rub bone-on-bone.

In surgery, we replace the ball with metal. On the socket side, we resurface the socket with a plastic piece  acts like new cartilage. Then the metal ball will slide over the new plastic piece and act like the original joint did.

There are two basic types of shoulder replacement. In a traditional shoulder replacement, we replace the ball and the socket in a normal manner. We use this on patients, who have functioning rotator cuff tendons. The rotator cuff is required to move the shoulder after a regular shoulder replacement.

Unfortunately, some patients don’t have functioning rotator cuff tendons or they’ve had chronic rotator cuff tears that have been neglected, progressing to osteoarthritis. In those patients, we use a reverse shoulder replacement. It’s called “reverse,” because we make the ball the socket and the socket the ball. That allows a patient to articulate(move) and use other muscles that are functioning to elevate their arm. This allows patients that have a nonfunctioning rotator cuff tendon to have normal function. For patients who don’t have a functioning rotator cuff tendon, this allows them to have forward elevation of their arm and to be able to move their arm better than they were before.

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