Don’t give it a cold shoulder

Dr Harpreet s Gill

Shoulder joint problems are a neglected lot in India. Lack of awareness amongst the general population is the key factor. Actually people accept the disability and don’t go for any kind of treatment. Right guidance and treatment in various stages of the disease can help the patient in regaining full movements of the shoulder and he/she can be pain free.

The success of hip and knee replacement is known by all; however, people are not aware of the success of shoulder replacements. Though  half shoulder replacement and total shoulder replacements are being done for various shoulder conditions, but the new treatment is reverse total shoulder prosthesis. This is called reverse shoulder replacement as normal ball and socket relationship of shoulder joint is reversed, creating a more stable joint with a fixed fulcrum. The metal ball is fixed to shoulder blade bone and the plastic cup with a metal stem is fixed to the upper arm bone (humerus).

Candidates for surgery:

The indications of reverse total shoulder replacements are:

• Management of patients who have irreparable loss of the rotator cuff (muscles around shoulder) and severe arthritis of the shoulder combined with severe loss of shoulder movements and function.
• A completely torn rotator cuff (muscles around shoulder) that cannot be repaired
• Proximal humerus (shoulder) fractures in elderly.
• In cases of shoulder fractures that have not united or are mal-united i.e. not united in the right position.
• A previous unsuccessful shoulder replacement 
• Severe shoulder pain and difficulty lifting your arm away from your side or over your head
• A complex fracture, a chronic shoulder dislocation or a tumour of the shoulder joint
• Failed treatments, such as rest, medications, steroid injections and physiotherapy, that have not relieved shoulder pain

Rehabilitation after surgery

This replacement was performed for the first time in India in 2011. The success rates of surgery have increased and patients don’t have to live their life in pain. In general, individuals are able to perform gentle activities of daily living with the operated arm starting four weeks after surgery. Driving should wait until six weeks if the surgery has been performed on the left shoulder because of the increased demands on the left shoulder for shifting gears. And the patient would be able to do activities he/she was not able to do before surgery by six weeks.

(Gill is a Ludhiana-based orthopaedic surgeon) 

As told to Poonam Bindra