Total shoulder joint replacement for shoulder arthritis: Surgery with a dependable, time-tested conservative prosthesis and accelerated rehabilitation can lessen pain and improve function in shoulders with arthritis.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Wednesday, January 09, 2008
Figure 12 - Continuous passive motion machine
Recovering from surgeryPain and pain management Recovery of comfort and function after shoulder arthroplasty
continues for the first year after surgery. The rehabilitation is
carried out largely by the patient under the supervision of the surgeon.
Shoulder replacement arthroplasty is a major surgical procedure that
involves cutting of skin, tendons and bone. The pain from this surgery
is managed by the anesthetic and by pain medications. Immediately after
surgery, strong medications (such as morphine or Demerol) are often
given by injection. Within a day or so, oral pain medications (such as
as hydrocodone or Tylenol with codeine) are usually sufficient. Use of medications Initially pain medication is usually administered intravenously or
intramuscularly. Sometimes patient controlled analgesia (PCA) is used
to allow the patient to administer the medication as it is needed.
Hydrocodone or Tylenol with codeine are taken by mouth. Intravenous
pain medications are usually needed only for the first day or two after
the procedure. Oral pain medications are usually needed only for the
first two weeks after the procedure.
Effectiveness of medications Pain medications can be very powerful and effective. Their proper
use lies in the balancing of their pain relieving effect and their
other, less desirable effects. Good pain control is an important part
of the postoperative management.
Important side effects Pain medications can cause drowsiness, slowness of breathing,
difficulties in emptying the bladder and bowel, nausea, vomiting and
allergic reactions. Patients who have taken substantial narcotic
medications in the recent past may find that usual doses of pain
medication are less effective. For some patients, balancing the benefit
and the side effects of pain medication is challenging. Patients should
notify their surgeon if they have had previous difficulties with pain
medication or pain control.Hospital stay After surgery the patient spends an hour or so in the recovery room.
A drainage tube is usually used to remove excess fluid from the
surgical area. The drain is usually removed on the second day after
surgery. Bandages cover the incision. They are usually changed the
second day after surgery.
Patients are discharged as soon as the incision is dry, the shoulder
is comfortable with oral pain medications, the patient can perform the
range of motion exercises, and the home support systems for the patient
are in place. Discharge is usually on the third or fourth day after
surgery.
Recovery and rehabilitation in the hospital Early motion after total shoulder replacement is helps achieve the
best possible shoulder function. Arthritic shoulders are stiff. One of
the major goals of total shoulder replacement surgery is to relieve
much of this stiffness. However, after surgery scar tissue will tend to
recur and limit movement unless motion is started immediately. This
early motion is facilitated by the complete surgical release of the
tight tissues so that after surgery the patient has only to maintain
the range of motion achieved at the operation.
A continuous passive motion (CPM) machine is often used to gently
move the shoulder in the recovery room immediately after surgery. The
CPM machine, shown in figure 12, is used for the first few days after
surgery whenever the patient is in bed.
During the hospitalization, the patient learns a simple
rehabilitation program that will be used for maintaining the range of
motion at home after discharge. Figures 13 and 14 show two of the
exercises used to maintain elevation and rotation of the arm. On the
day of surgery or on the day after, the physical therapist teaches the
patient gentle range of motion exercises. The patient is usually shown
how to stretch the shoulder forward and out to the side, preventing
stiffness and adhesions.
Walking and use of the arm for gentle activities are encouraged soon after surgery.
Hospital discharge At the time of discharge, the patient should be relatively
comfortable on oral medications, should have a dry incision, should
understand their exercises and should feel comfortable with the plans
for managing the shoulder. For the first month or so after this
procedure, the operated arm may be less useful than it was immediately
beforehand.
The specific limitations can be specified only by the surgeon who
performed the procedure. It is important that the repaired tendons not
be challenged until they have had a chance to heal. Usually the patient
is asked to lift nothing heavier than a cup of coffee for six weeks
after the surgery.
Management of these limitations requires advance planning to
accomplish the activities of daily living during the period of recovery.
Convalescent assistance Patients usually require some assistance with self-care, activities
of daily living, shopping and driving for approximately six weeks after
surgery. Patients usually go home after this surgery, especially if
there are people at home who can provide the necessary assistance, or
if such assistance can be arranged through an agency. In the absence of
home support, a convalescent facility may provide a safe environment
for recovery.
Recovery of comfort and function after shoulder arthroplasty
continues for many months after the surgery. Improvement in some
activities may be evident as early as six weeks. With persistent
effort, patients make progress for as long as a year after surgery. Surgery for shoulder arthritis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-7416 to make an appointment.
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