Transcript Treatment Options for Shoulder Pain

Treatment Options for
Severe Shoulder Pain
Anatomy of the Shoulder
Made up of 3 bones:
• Scapula (shoulder
blade)
• Humerus (upper
arm bone)
• Clavicle
(collarbone)
(Collarbone)
(Shoulder Blade)
(Upper arm
bone)
Shoulder Facts
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Most complex joint
in the body.
One of the few
joints with 360
degrees rotation.
Extensive array of
ligaments and
muscles.
Shoulder Joint
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Healthy
shoulder joint
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Arthritic
shoulder joint
Causes of Shoulder Pain
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Osteoarthritis (wear
and tear)
Rheumatoid arthritis
Rotator cuff tears
Shoulder impingement
(bursitis and tendonitis)
Repeated dislocations
or fractures
Trauma
Symptoms of Shoulder Arthritis
• Pain:
• Centered in the back of shoulder if
glenohumeral shoulder joint is affected.
• Focused on the front of the joint if AC joint is
affected.
• Rheumatoid arthritis will affect both of these
areas.
• Reduced/Loss of range of motion
• Grinding or catching sensation
• Stiffness
Preparing for Examination
• Have the following information ready
for your exam:
• Chief complaint (Where it is hurting the
most?)
• Chronology of illness
• What effect does the pain have on your
life?
• Family history
Diagnosing Shoulder Arthritis
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Physical examination
Medical history review
Strength and Motion test
X-Rays
Arthrogram
Magnetic Resonance Imaging (MRI)
Blood tests
• Blood Count
• Rheumatoid Factor for rheumatoid arthritis
• C-Reactive Protein
How Can My Life Change
with Treatment?
A return to mobility.
• Regaining a sense of your
former lifestyle.
• A change in your pain
symptoms
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Non-surgical Treatment Options for
Shoulder Pain:
Over-the-Counter Medications
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)
• Usually first drug used to treat arthritis
• Can reduce pain, swelling and redness
• Relief can take several months
• Examples:
• ibuprofen (Advil®, Motrin®)
• naproxen (Aleve®)
• Aspirin
• Reduce joint pain and inflammation
• Form of NSAIDs
Non-surgical Treatment Options for
Shoulder Pain: Over-the-Counter
Medications
Acetaminophen
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Reduces pain
Lowers fever
Does not reduce inflammation of arthritis
Examples:
• Tylenol®
• Datril® Extra Strength
• Tempra®
Non-Surgical Treatment Options for
Shoulder Pain: Prescription Medications
• NSAIDS
• Most popular type for osteoarthritis treatment
• Includes ibuprofen (Motrin®), naproxen sodium
(Anaprox®), oxaprozin (Daypro®), sulindac
(Clinoril®) , etc.
• Analgesics
• Provide pain relief, but do not reduce inflammation
• Includes Acetaminophen with codeine (Tylenol® with
Codeine), Oxycodone (OxyContin®, Roxicodone®),
Hydrocodone with acetaminophen (Vicodin®,
Dolacet®), etc.
Non-surgical Treatment Options for
Shoulder Pain: Prescription Medications
• Biological response modifiers
• Treat rheumatoid arthritis; may postpone injury to the joints
• Includes: Infliximab (Remicade®), Etanercept (Enbrel ®)
• Glucocorticoids or corticosteroids
• Treat rheumatoid arthritis; fight inflammation
• Includes: cortisone, hydrocortisone (Cortef®, Hydrocortone®),
Prednisolone (Prelone®)
• DMARDS
• Treat rheumatoid arthritis; slow joint destruction
• Includes: methotrexate, injectable gold, penicillamine (Depen®),
Azathioprine (Imuran®), etc.
Non-surgical Treatment Options for
Shoulder Pain
• Cortisone injections
• Powerful anti-inflammatory medication
• Temporary pain relief lasting several weeks
to months
• Small risk of infection
• Activity modification
• Assistive devices, such as reachers
• Physical therapy
Surgical Options for Shoulder Pain
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Synovectomy
Arthroscopy
Soft tissue repair
Shoulder replacement surgery
• Reverse shoulder replacement
• Hemiarthroplasty
• Total shoulder replacement
Synovectomy
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Early stages of rheumatoid arthritis.
Removes inflamed tissue lining.
Potentially saves joint from further
damage.
Synovectomy, continued
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Small incision is made.
Arthroscope is used to inspect the joint.
Diseased synovium is removed.
Sling may be required.
Physical therapy usually required.
Synovectomy, continued
Benefits
• Alleviates rheumatoid arthritis pain in the
joint
• Joint may be saved from further damage
• Synovium could grow back over time
• Disadvantages
• Not a permanent solution
Arthroscopic Surgery
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Used when osteoarthritis causes small
pieces of cartilage to wear away from
joint and float around.
Removes any debris and smoothes
cartilage surfaces.
Potentially saves joint from further
damage.
Arthroscopic Surgery
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A small camera is inserted into the
shoulder through small incisions, allowing
the doctor to see inside the joint.
Arthroscopic Surgery
Benefits
• Less invasive option may lead to shorter
recovery time
• Smaller incisions
• Can be performed on an outpatient basis
• Risks (common to all surgeries)
• Infection
• Excessive bleeding or swelling
• Formation of blood clots
• Damage to adjacent tissue
Soft Tissue Repair
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Tissue patch used to reinforce rotator
cuff repair.
Fixes over an area of weakened or
damaged soft tissue.
Provides a framework for new tissue to
grow.
Gradually the patch disappears until
only your own tissue remains.
Soft Tissue Repair, continued
Benefits
• Adds strength and durability to tissue
• Less-invasive
• Risks (common to all soft tissue repairs)
• Infection
• Instability
• Increased stiffness
• Adhesions
When is Shoulder Replacement
Surgery Right for You?
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Experience significant pain.
Reduced or loss of function despite
non-surgical treatments.
Quality of life has significantly
changed.
Medications for pain are no longer
effective.
Total Shoulder Replacement
There are over 16,000
shoulder replacements each
year.1
• Surgeon will decide the type
of shoulder replacement.
• Choice is based on age,
lifestyle and the surgeon’s
experience.
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1. www.jointreplacement.com
Shoulder Replacement Components
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The metal humeral
component replaces the
ball on the top of the
stem and fits into the
upper arm bone.
The plastic glenoid
component replaces the
socket of the shoulder.
Shoulder Replacement
• Depending on the damage, the surgeon
may replace:
• Only the humeral head (hemiarthroplasty)
• Both the humeral head and glenoid
Reverse Shoulder Replacement
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Designed for end-stage cuff tear
arthropathy sufferers
Extreme shoulder degeneration; cannot
function normally
May improve motion and stability by
changing shoulder mechanics
Reverse Shoulder Replacement,
continued
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Because the shoulder mechanics have
been reversed, the stronger muscles can
now lift the arm.
Reverse Shoulder Replacement
Candidates
• Recommended for patients:
• Age 70 years or older
• Experience significant pain
• Have little to no movement in their shoulder
• Not Recommended for patients:
• With bone disease, deficiencies in the scapula
or non-functioning deltoid muscles
• Younger or physically active
Potential Benefits to Patients
from Surgery
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Return to mobility
Restore their lifestyle
Freedom
Individual results may vary. There are potential risks and
recovery can take time. The performance of any new joint
will depend on your weight, activity level, age and other
factors.
Surgical Procedure
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Patient is anesthetized.
Incision is made on the shoulder.
The ball portion of the humeral head is
removed.
Surgical Procedure, continued
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The humeral and glenoid implant
components are inserted.
Incision is closed.
A shoulder splint or immobilizer may be
worn after surgery.
Preparing for Joint
Replacement Surgery
• Ease anxiety by mentally preparing with:
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Breathing exercises
Meditation
Imagery
Talking with friends and family
• Learn more about shoulder replacement
surgery:
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Brochures
Handouts
Websites
Videos
The Night Before Surgery
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Avoid medications, such as “blood
thinners” (aspirin, ibuprofen, etc.).
Do not consume any food or liquid after
midnight.
Make sure you have everything you’ll
need at the hospital.
Ask any questions you may have before
surgery.
After Surgery
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Switch to a pain medicine taken by
mouth after a day or so.
Gentle basic range-of-motion exercises
begin after leaving recovery room.
Two in-patient treatments per day while
in hospital.
Hospital Discharge
• You will be released from the hospital as soon
as:
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The incision is dry.
Comfortable taking only oral pain medication.
Able to perform the range of motion exercises.
Home support system is in place.
• Average recovery period lasts three to six
months.
A Caregiver’s Role
• Provide support and show patience
• Help with needs that the patient can
not do, like:
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Meal preparation
Grocery shopping
Laundry
Driving to medical appointments
Physical Therapy After Surgery
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Begins one day after surgery.
Starts with information gathering about
day-to-day problems, testing strength,
range of motion, palpation, etc.
Develop a treatment plan.
Recovery in the First Week
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Expect personal limitations on activities.
Important to limit any sudden or
stressful movements to your shoulder.
May be required to wear a sling or
protective device for at least a month
after surgery.
Recovery in the First Month
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Stitches are removed seven to 10 days
after surgery.
A formal physical therapy program
begins 10 to 14 days after surgery.
Shoulder should continually improve up
to six months after surgery.
Recovery After Six Weeks
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Ability to return to work will depend on
progress and type of work.
Driving should wait until you can
perform the necessary functions
comfortably.
No contact sports or any heavy lifting
for at least six months.
Questions?
Thank you!