Dr
Patrick HOUVET/F.I.H.S
What is arthrosis of the shoulder ?
Arthrosis is the consequence of the general "wear and tear"
of the joint cartilages. When the cartilage disappears, the bones
rub each other causing pain and stiffness.
Arthrosis affects more the hip or the knee than the shoulder, as
they cannot bear the weight of the body. However, the shoulder is
the joint with greater mobility of the body and can be involved
in hard and/or repetitive tasks from an early stage.
Arthrosis does not exceptionally affect people that are over 60
years old. It is more common among women than men, bilateral affection
is frequent at different clinical and radiological stages
Which are the symptoms ?
At first, patients exhibit pain on motion. Then, the pain becomes
permanent,
and it does not allow to sleep on the affected side. Loss of strength
occurs, and the patient can hardly carry things.
Which are the examinations required ?
It is likely to establish diagnosis with radiographs of the shoulder.
Posterior/anterior radiographs reveal a joint impingement, which
is related to the disappearance of the thickness of the cartilage,
osseous densification, sometimes osteophytes - bony spurs- and even
geodes. Destruction may be significant.
How is it treated ?
Injections and physical therapy help release pains. Injections should
not be administered
in excess. Sometimes clinical treatments do not help control pain,
then, it is resorted to surgery, particularly prosthesis.
If the cuff rotators, that is, the muscles that surround the head
of the humerus, are intact or fairly intact, the best way to eliminate
pain and regain mobility is to place a shoulder prosthesis. They
have been on the market for about 25 years, and the principle is
similar to a hip prosthesis.
Shoulder Prosthesis can be total, i.e. a replacement of two joint
surfaces -depression of the scapula glen and humeral head- , or
it can be a hemiasthroplasty through the replacement of the humeral
head only without involving the glene.
The
affected joint surfaces are replaced, on the side of the humerus,
by a metallic piece, and on the side of the scapulus by a polyethylene
piece. Pieces can be sealed with or without cement.
Surgical procedure is performed under general anaesthesia. When
the patient wakes up, the arm is immobilised by means of a simple
dressing. Drain is removed after some days. The prosthesis fusion
is made during the procedure. Therefore, union is not expected,
and rehabilitation starts early. Hospitalisation lasts less than
a week.
Which are the specific risks ?
 They are
the same as the ones of the prosthesis of the hip surgery:
intolerance of the material or infection -which is rare.
wear and tear of the polyethylene piece.
What about recovery after surgery ?
Postoperative rehabilitation is initiated in the first days. Its
aim is to maintain mobility of the shoulder, protecting always the
ligament and tendon reparations around the prosthesis.
Rehabilitation depends on the case, and it is performed in three
stages :
during the
3 first weeks, mobilisation of the shoulder is only passive, that
is, performed by the therapist ; it is preferable to avoid working
with pulleys. However, you can move the elbow, wrist and fingers
normally.
between
the third and sixth week, the physical therapist will show you
how to contract the muscles without motion, this is the isometric
contraction. He/She will also help you to start moving the shoulder
by yourself : assisted active rehabilitation.
after
the sixth week, you will gradually return to normal activity.
Rehabilitation lasts from 3 to 6 weeks, it should be progressive
and painless.
Which are the results ?
Results depend on the initial condition of the muscles, bones
and ligaments. According to statistics, 80% of the patients regain
a painless shoulder, with a reduction -of one third- of mobility,
compared to a normal shoulder.
|
