pathologies
Shoulder
Shoulder osteoarthritis
treatment
How is osteoarthritis of the shoulder (omarthrosis) treated?
Treatment of osteoarthritis must start with the most basic measures. We usually start with physiotherapy.
Anti-inflammatory drugs can relieve this pain temporarily; mobility improves as pain diminishes. Unfortunately, the effet of these drugs is not uniform, and response to treatment differ from patient to patient.
Infiltrations with cortisone reduce inflammation and can greatly reduce pain. The effet of these infiltrations can last for weeks, months, allowing us to make an eventual surgical procedure wait. Given the secondary effet of these drugs, we recommend no more than one to two infiltrations per year.
The therapeutic response to visco-supplementation remains limited.
Shoulder arthroscopy - arthroscopy removes existing joint debris, regularizes old tendon lesions or fixe tendons that by their inflammation are the cause of pain.
Shoulder arthroplasty or shoulder prosthesis placement
When all these treatments have failed, or if the joint is so destroyed that there is no other solution, we plan arthroplasty with the fitting of a shoulder prosthesis.
Shoulder prosthesis
The best-known indication for shoulder prosthesis is osteoarthritis.
Several types of prosthesis are available on the market, and shoulder prostheses are currently also indicated for other pathologies (shoulder fracture, irreducible shoulder subluxation, major shoulder instability, humeral head necrosis, etc.).
We will confine ourselves to a brief description of the shoulder prosthesis procedure.
The anatomic shoulder prosthesis and the inverted prosthesis will be described, as they are frequently used.
The anatomical prosthesis
The osseous, articular and arthritic surface will be removed and replaced by shoulder prosthesis implants.
This shoulder prosthesis consists of a metal stem (often chromium-, cobalt- or titanium-based alloys) which has a metal sphere in its proximal or upper part. This represents the head of the humerus.
On the scapula side, the polyethylene implant replaces the destroyed cartilage of the scapula glenoid. Implants can be cemented into the bone or uncemented (the surface of the prosthesis is induced with a product that acts as a "biological glue").
Inverted shoulder prosthesis
This is a shoulder joint replacement or special prosthesis. The indications for this prosthesis are différentes to an anatomical prosthesis.
The prosthesis consists of a ball attached to the scapula and a stem with a cup placed at the upper end of the humerus.
This cut of the upper part of the stem will articulate with the hemisphere implanted in the scapula.
A new joint is thus created, with the gap between the two metal components filled by a polyethylene insert.
This type of prosthesis has limited indications and is mainly intended for elderly patients with large ruptures in the tendons or muscles that usually stabilize the shoulder, or in the case of a complex fracture.
Recovery after insertion of this type of prosthesis is often comparable with that of anatomical prostheses, but amplitudes will be less (especially internal rotation of the arm).
Possible complications
These are complications that occur only rarely, and the patient should be informed of them, as they may interfere with full functional recovery of the operated shoulder. Infection, head subluxation, nerve damage and secondary stiffness are the most frequently encountered complications.
In general, the results of these prostheses depend on the surgical indications, the pre-operative condition of the shoulder, the surgeon's experience and, above all, on appropriate rehabilitation.
diagnosis
The surgeon initially requests an X-ray of the shoulder. He will then decide whether further tests are required (arthroscanner, CT scan, MRI, shoulder ultrasound).
X-rays immediately show the disappearance of the joint line, the space normally found between the head of the humerus and the scapula. This space is normally filled by cartilage, which gradually diminishes as it wears away.
symptoms
The most important symptoms are pain, limited mobility with shoulder stiffness and swelling of the joint. These symptoms tend to progress, but what's interesting is that they don't always progress steadily over time.
Often patients can describe months when the shoulder is less painful. Symptoms are influenced by climate change.
Definition
Your shoulder hurts and you've been told you have osteoarthritis. Normally, cartilage (the elastic layer covering the articular surfaces of the bone) protects the bone ends and absorbs shocks between them.
Osteoarthritis is characterized by the progressive wearing away of cartilage in the joint. The disappearance of this cartilage leaves the bone exposed; friction between the bone ends is often the cause of shoulder pain. This wear is accompanied by inflammation of the joint capsule and surrounding area.
Osteoarthritis generally affects patients over the age of 50; it is more frequent in patients with a history of shoulder fracture. There is also a genetic predisposition.