Are You In Need of a Total Shoulder Replacement?

Most people are at least somewhat familiar with total knee replacements, even if you don’t understand the full scope of the procedure; but total shoulder replacements are not quite as publicized.  Total shoulder replacements are a common procedure for shoulder ailments, but they are still far less common than total knee and total hip replacements.

Why does one undergo a total shoulder replacement?  Often pain from arthritis spurs an individual to decide to have a total shoulder replacement, also known as a total shoulder arthroplasty (TSA).  Osteoarthritis is also referred to a degenerative joint disease and results from gradual “wear and tear” on the joint from an accumulation of life’s activities.  The cartilage that typically protects the ends of the bones wears away which results in “bone on bone” rubbing at the shoulder joint when the arm is moved.  Arthritis can also develop in the shoulder from a traumatic injury like a fracture (broken bone) of the shoulder or arm, chronic rotator cuff injuries or weakness, or other injuries to the shoulder area that cause instability.  These injuries can result in a loss of function and the need for a TSA in the future.  Arthritis typically effects people around the age of 50, but can occur at a younger age especially if an injury occurred at the joint earlier in life.  Rheumatoid arthritis is a different arthritic condition that causes chronic inflammation around the joint resulting in cartilage loss, pain, and stiffness.  This condition usually presents itself earlier in life around the age of 30 and can also lead to the need for a TSA.  Another condition that can also lead to joint damage and the need for a TSA is avascular necrosis.  This condition occurs when the blood supply to the bone is disrupted resulting in degeneration of the joint.  It can occur for a variety of reasons including chronic steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease, and heavy alcohol use.

What does a total shoulder replacement entail?  The extent of a total shoulder replacement can vary based on the amount of damage along the joint surfaces.  The shoulder joint is what is called a ball and socket joint.  The top of the humerus bone which is located along the upper arm forms the ball of the joint and the socket of the joint is what is called the glenoid.  The glenoid is actually a portion of the shoulder blade that makes a shallow cup-like socket for the ball of the humerus to sit in.  The ball, the socket, or both can be replaced by removing the damaged portion of the joint and replacing it with an artificial component called a prosthesis.

Is a shoulder replacement right for you?  Conservative treatments like physical therapy for the shoulder should be attempted prior to undergoing a total shoulder replacement, because arthritis can often be managed with exercise programs and adjustments in form during various activities; but the condition can become severe enough that a TSA is the only option.  Severe shoulder pain that interferes with daily function, moderate to severe pain at rest that disrupts sleep, loss of motion or weakness at the shoulder that effects function, and a failure to improve with conservative treatments like physical therapy, anti-inflammatory medications, or cortisone injections are all reasons to consider a total shoulder replacement.  Individuals with depression, obesity, diabetes, Parkinson’s disease, multiple previous shoulder surgeries, shoulder joint infections, rotator cuff deficiency, and severely altered shoulder anatomy are not ideal candidates for the procedure.  Individuals with rotator cuff deficiency may instead be candidates for a reverse total shoulder replacement.  This procedure will be discussed more in depth in our next blog.  Talk to your doctor or physical therapist if you feel that a TSA may be right for you.


Pain: Our Body’s Way of Communicating

In case you were not aware, September is Pain Awareness Month.  In the past we have done several blogs related to pain including referred pain, the “no pain, no gain” philosophy, sciatic nerve pain, and fibromyalgia.  If you are interested in any of these topics related to pain, click on the hyperlinks provided or refer to the blog list on our website.  Pain is one of the body’s many ways of communicating with us.  Typically, pain is an indicator that something is amiss within the body.  This is why understanding pain is so important. 

Pain is a warning sign that the nervous system of the body produces in order to help protect our bodies from harm.  Individuals who experience pain from conditions like fibromyalgia or complex regional pain syndrome (CRPS) may have heard from someone along the way that their pain is all in their head.  While this is not the best way of approaching either of these conditions, there is some truth within this statement; however, it would be more accurate to say that ALL people’s pain is in their head.  Pain is the brain’s response to an irritating stimulus, but the triggers for some people may not be the same as the triggers for others.  One person may feel minimal to no pain when being pricked by a needle while another individual may feel that the pain produced by the same stimulus is the worst pain imaginable.  The same event has occurred for the two individuals, but each person’s brain processes the event differently. 

Acute pain is the type of pain that occurs immediately after a negative stimulus.  It causes the body to produce a pain signal warning the person that something is wrong.  Depending on the problem that caused the acute pain, once the cause is known and treated, then the pain will go away.In the case of chronic pain, pain is produced for an extended period of time (weeks, months, or years) following the negative stimulus.  Sometimes there is a continued cause for pain to occur over an extended period of time like arthritis or cancer; but often there is no longer a stimulus that is causing the pain to remain present.  Why chronic pain persists in some individuals and not in others is not fully understood; but, once again, the brain’s processing of pain is what allows the body to feel the continued sensation.  There is no true cure for chronic pain, but there are ways to manage it including physical therapy, medication, acupuncture, electrical stimulation, surgery, psychotherapy, relaxation and meditation therapy, biofeedback, and behavior modification.  It is important to note that avoiding activity and exercise does not help to overcome chronic pain.  In fact, use of a regular fitness routine can assist in managing the condition.  Arthritis, fibromyalgia, and CRPS are all examples of chronic pain conditions that respond negatively to a lack of activity.  A physical therapist can help you determine the proper balance of rest and activity depending on your pain condition. 



Is that Latest Shoe Trend Right for You? (cont.)

In our last blog we discussed rocker bottom/toning shoes.  In this blog we will discuss toe shoes or five finger running shoes.  I’m sure you have seen these shoes worn by various people both for walking and running.  Some people hate them, while others won’t stop ranting about them.  So what’s the full scoop?

These toe shoes are designed to provide minimal support to the foot in order to simulate barefoot walking and running with less risk to the individual wearing them than having completely bare feet.  The shoe promotes pressure being place toward the ball of the foot versus the heel during running activities.  With all of that being said, is this form of shoe actually good for you?

The argument for “barefoot” style running is that our bodies were initially designed for running barefoot versus in a ridged shoe.  On the flip side, our bodies were also designed for running on dirt and grass versus asphalt and concrete.  The impact that these harder surfaces provide can be damaging to the foot and can cause ligament strains or even stress fractures in the feet.  Despite the fact that our bodies may have initially evolved to walk/run without footwear, not everyone is exactly the same and individuals may have foot problems right from the start.  People with various foot conditions may need the extra support that more rigid footwear can provide while others may receive benefit from the minimal support that the toe shoe provides. 

The other important component of the minimalist toe shoe is that it promotes forefoot strike during running.  In other words, the shoe makes you land on the ball of your foot while you run.  There are several minimalist styles of shoe that also promote this forefoot strike, but is that a good thing?  Forefoot strike actually increases the amount of tension that is places on the Achilles’ tendon and calf musculature which may lead to more injuries in the area.  Research has also shown that using a heel strike (landing toward the heel of the foot) during running is more energy efficient.  This means that people who use a heel strike during running have the potential to use less energy and oxygen while running at the same intensity as a person using a forefoot strike.

The minimalist toe shoe is much like any other type of shoe.  It may work for some people and be harmful for others.  The ideal candidate for toe shoes/five finger running shoes would be an individual who already uses forefoot strike while running, lands softly, and has a relatively flexible arch that does not overly pronate (position that causes a dropping of the arch of the foot).

Just because a certain type of shoe is trending at the moment does not mean that it is the healthiest option or the best one for your body.  Do your homework and find what fits you best.  If you have concerns about what shoe may be the best fit for you, talk to your physical therapist. 





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  Disclaimer:  The information in this medical library is intended for informational and educational purposes only and in no way should be taken to be the provision or practice of physical therapy, medical, or professional healthcare advice or services. The information should not be considered complete or exhaustive and should not be used for diagnostic or treatment purposes without first consulting with your physical therapist, physician or other healthcare provider. The owners of this website accept no responsibility for the misuse of information contained within this website.