Shoulder Surgery
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The shoulder is a ball-and-socket joint. The ball portion of the joint
is called the humeral head, and is part of the humerus (upper arm bone).
The socket portion is called the glenoid, and is part of the scapula (shoulder
blade). The humeral head fits into the glenoid and the two bones rub together
as the shoulder moves.
Ball and socket of healthy shoulder joint surfaces In a healthy shoulder joint, the surfaces of these bones where the ball
and socket rub together are very smooth and covered with a tough protective
tissue called cartilage. Arthritis causes damage to the bone surfaces
and cartilage. The damaged surfaces eventually become painful as they
rub together.
Arthritic shoulder joint surfaces There are many ways to treat pain caused by arthritis. One way is total
shoulder-replacement surgery. The decision to have total shoulder-replacement
surgery should be made very carefully after talking to your physician
and learning as much as you can about the shoulder joint, arthritis and
the surgery.
In total shoulder replacement surgery, the ball and socket that have been
damaged by arthritis are removed and replaced with artificial parts made
of metal and a very durable plastic material. The artificial parts are
called “implants.” These implants are shaped so that the shoulder
joint will move very similar to the way the joint moved when it was healthy.
The patient is taken into the operating room and positioned on a special
operating table as though lounging in a beach chair. The arm is placed
on a board that will allow the surgeon to move it up or down as necessary
during the surgery. Anesthesia is given. When it has taken effect, the
skin around the shoulder and upper arm is thoroughly scrubbed and sterilized
with an antiseptic liquid.A 6-inch incision is made over the shoulder
joint. The incision is gradually made deeper through muscle and other
tissue until the bones of the shoulder joint are exposed.
What to Bring to the Hospital
Below is a list of things you may want to bring with you to the hospital
in preparation for your surgery. Talk with your physician as he/she may
have additional information about preparing for your hospital stay.
- Your personal belongings should be left in the car until after surgery.
Tell your family that your room will be assigned when you are in surgery
or in recovery, at which point they can bring your personal items to your room.
- Personal grooming items that you may want to pack include a toothbrush,
toothpaste, hairbrush, eyeglasses/contacts, comb, deodorant, shaving cream/electric
razor, shampoo, lotion, undergarments, and a robe.
- Bring slippers or flat rubber-soled shoes for walking in the hallways.
- Bring loose-fitting clothing for your trip home.
- Bring any medications you are currently taking. You should also write down
your medication information to be given to the hospital staff. Be sure
to include the name, strength, and how often you take the medications.
Please communicate any allergies you might have to your doctors and the
nursing staff.
- If you use a breathing exerciser (IBE), be sure to bring it with you from
home, as you will probably need this right after surgery.
- Leave jewelry, credit cards, car and house keys, checkbooks, and items
of personal value at home. Bring only enough pocket money for items such
as newspapers, magazines, etc.
Getting to the Joint
The patient is taken into the operating room and positioned on a special
operating table as though lounging in a beach chair. The arm is placed
on a board that will allow the surgeon to move it up or down as necessary
during the surgery. Anesthesia is given. When it has taken effect, the
skin around the shoulder and upper arm is thoroughly scrubbed and sterilized
with an antiseptic liquid.
An incision about six inches long is made over the shoulder joint. The
incision is gradually made deeper through muscle and other tissue until
the bones of the shoulder joint are exposed.
Socket implant The implant that replaces the socket consists of a durable plastic insert
with a very smooth, cupped surface.

Removing the surface of the socket The arm is maneuvered until the humeral head is dislocated from the socket.
Special precision instruments are used to remove the damaged cartilage
and bone surface from the glenoid, and to shape the socket so it will
match the shape of the implant that will be inserted. Holes are drilled
into the socket to accommodate the fixation pegs on the implant. The pegs
help stabilize the implant. The socket implant is attached by using a
special kind of cement for bones.
Socket Prepared for Implant
Inserting the implant The socket implant is attached by using a special kind of cement for bones.
The cement is pressed into the holes. The implant is then inserted.
Glenoid Implant

Replacing the ball portion of the joint The implant that replaces the ball consists of a long metal stem that
fits into the humerus. A metal head in the shape of a partial sphere is
mounted on top of the stem. The head meets the socket implant in the shoulder blade.
Metal Implant to Replace Ball Portion of Shoulder Joint

Preparing the humeral canal The upper arm bone has relatively soft, porous bone tissue in the center.
This part of the bone is called the “canal.” Special instruments
are used to clear some of soft bone from the canal. Using a precision
guide and saw, the damaged rounded portion of the humerus is removed.
Humeral Head (Ball) Is Removed
Inserting the implant The metal stem implant is inserted into the canal. It can be held in place
by either using the special bone cement or by making it fit very tightly
in the canal. The surgeon will choose the best method, depending on the
patient’s age and expected activity level.
On some implants, the stem and partial sphere are one piece. On others,
they may be two separate pieces. If the partial sphere is a separate piece,
it usually is secured to the top of the stem after the stem has been inserted.
Stem Implant with Partial Sphere



Closing the Wound
When all the implants are in place, the surgeon places the new ball that
is now part of the upper arm bone into the new socket that is part of
the shoulder blade. If necessary, the surgeon may adjust the ligaments
that surround the shoulder to achieve the best possible shoulder function.
When the ligaments are properly adjusted, the surgeon sews the layers of
tissue back into their proper position. A plastic tube may be inserted
into the wound to allow fluids to drain from the site for a few hours
after surgery. After the tube is inserted, the edges of the skin are sewn
together, and a sterile bandage is applied to the shoulder. Then the patient
is taken to the recovery room.
After Shoulder Surgery
Here are some ways to promote healing and begin movement after you have
had shoulder-replacement surgery. Discuss these techniques with your physician
before attempting them. Your physical therapist may modify some of the
techniques for you. Do only the techniques that are recommended by your
physician or therapist. If you have questions, discuss them with your
surgeon before you are discharged from the hospital.
- Avoid many household chores that require the use of your surgery arm. Examples
are mopping, using a vacuum and sweeping. Use long-handled feather dusters
for dusting high and low items. Your physician will tell you when it is
OK to do these activities.
- Be careful to avoid falls.
- Be certain not to exceed the range-of-motion restrictions given by your
physician.
- Constipation is a common problem for patients following surgery. This usually
is due to your limited activity and pain medicines. Discuss your diet
with your physician. It should include fresh fruits and vegetables and
eight full glasses of liquid each day unless your physician tells you
otherwise.
- Do not use your affected arm to get out of bed or from a chair position.
Use the opposite arm.
- Remember that you probably will tire more easily than usual. You may want
to plan a rest period of 30 to 60 minutes midmorning and midafternoon.
- Sling use will vary, depending on the situation. Your physician may tell
you to wear the sling every night for at least the first month.
- Some swelling around the incision is normal. You will find it more comfortable
to wear loose clothing to avoid pressure on the incision. Ask your physician
or other qualified health professional about appropriate wound care.
- The amount of weight you can lift using your affected arm will be limited.
Your physician may recommend that you do not lift anything heavier than
a cup of coffee for the first four to six weeks.
- You may be advised against pulling anything, such as pulling up pants and
opening doors, for six weeks after surgery.
- You may experience less pain after surgery, which may make you believe
you can do more. Be certain to follow your physician’s instructions
so you don’t overdo it.
- You may want to place a pillow behind your elbow when seated or lying down
to keep the surgery area forward to help decrease pain.
- You likely will need to avoid contact sports after surgery. Your physician
will discuss restrictions with you.
- Your physician may recommend applying ice to your shoulder to help decrease
pain. A 2-pound bag of frozen peas or other small vegetables works as
well as an ice pack.
- Your physician likely will give you a list of exercises to do when you
get home. Typically, you will be asked to do these four or five times
a day for a month or more. Follow the instructions you receive.
- Your physician probably will give you a prescription for pain medicine.
Please follow your physician’s instructions.