Shoulder replacement

Shoulder replacement treats a worn joint surface. The most common reason is osteoarthritis, where the cartilage of the ball and socket has thinned to the point that motion is painful and the shoulder grinds and stiffens. Other reasons include cuff tear arthropathy — arthritis in a shoulder with a long-standing, irreparable rotator cuff tear — inflammatory arthritis, avascular necrosis and certain complex fractures.

The decision is driven by symptoms rather than by an x-ray alone: pain that interrupts sleep, difficulty with dressing, reaching and carrying, and loss of motion that has not responded to non-operative care.

Shoulder arthritis usually develops gradually, and many patients adapt around it for years before seeking care.

Evaluation is reasonable when shoulder pain interrupts sleep, when motion is progressively lost, or when therapy, activity modification and injections are no longer controlling symptoms. Replacement is a quality-of-life operation; the right timing is when the shoulder is limiting the life you want, not when an x-ray reaches a particular grade.

Assessment includes a detailed examination of motion, strength and rotator cuff function, plus x-rays in standard views. A CT scan is often obtained to characterize the shape and wear pattern of the glenoid, which guides implant selection and positioning. MRI may be used when the condition of the rotator cuff is uncertain.

Therapy to maintain motion and periscapular strength, activity modification, anti-inflammatory measures and corticosteroid injections can meaningfully help some patients and delay the need for surgery. These options are reviewed before replacement is recommended.

In an anatomic replacement, a metal ball replaces the humeral head and a plastic socket resurfaces the glenoid, reproducing normal anatomy. It relies on a functioning rotator cuff to position and power the shoulder.

In a reverse replacement, the ball is fixed to the socket side and the cup to the humerus. This changes the mechanics so the deltoid muscle can lift the arm, which makes it the right choice when the rotator cuff is deficient, when there is cuff tear arthropathy, or in certain fracture and revision situations.

A sling is used initially to protect the repair of the soft tissues around the implant. Range of motion begins early within the limits of the procedure performed, and strengthening is added once the tissues have healed sufficiently.

Pain relief is typically the first thing patients notice; functional gains continue over the months that follow as motion and strength improve. Written rehabilitation protocols are provided and progress is reviewed at scheduled follow-up visits.

Dr. Horner is a board-certified orthopedic surgeon with fellowship training in sports medicine and shoulder surgery at Rush University Medical Center. Implant choice is matched to the individual shoulder — the wear pattern of the socket and the state of the rotator cuff — rather than to a single default.

Patients are seen at Oak Brook on Mondays, Little Village on Wednesdays and St. Charles on Thursdays.