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Shoulder & Elbows
Is Total Elbow or Shoulder Replacement
Right For Me?
Roger H. Emerson, Jr., M.D.
Total elbow and total shoulder replacement
prosthesis have been available almost as long as hip and knee
replacements. You probably have heard very little about this
type of joint replacement because it is not as commonly performed
as hip and knee replacement. Why is this the case? Upper extremity
arthritis is simply not as restrictive or painful as lower extremity
arthritis.
Even limited walking requires that we put our
full weight on our hips and knees. In fact, there is three to
five times body weight across our hips and knees with simple
standing and walking due to the long lever arms of our bones.
A cane or walker only relives part of this load. On the other
hand, we can protect an arm by limiting heavy use of the hand.
Therefore, many patients can "live" with an arthritic
elbow or shoulder, while they cannot do so with an arthritic
lower extremity joint.
Unfortunately, many patients experience arthritis
pain in the elbow or shoulder that is present at rest as well
as with activity. Many times this "rest pain" predominates
at night, preventing sleep. Medication can frequently relieve
arthritic pain, especially when the arthritis is mild, and should
be tried and used carefully. If medical management of the arthritic
pain is not sufficient, and the joint has been destroyed by
the arthritis, then joint replacement is the only alternative.
While walking is the most important use of
the legs, the most important use of the arm is to position the
hand. Clearly if the loss of joint motion is significant, then
the ability to use the hand is diminished.
Although full restoration of joint motion is
not guaranteed with surgery, improvement in motion is usually
seen after upper extremity joint replacement. The harder a patient
works on the rehabilitation exercises, the better the joint
will function. Most patients will gain "functional"
motion, meaning that they will gain enough motion to perform
all of the normal activities of daily living.
Most of the patients at the TCJR who have their
elbows replaced have rheumatoid arthritis. The goal of surgery
for these patients is pain-free sleeping and use of the arm for
activities of daily living, such as eating, dressing, and light
household and office activities. Elbow replacement is not designed
to permit return of heavy, strenuous activities, but carrying
of shopping bags and small suitcases is permitted. Elbow replacement
will reliably restore elbow flexion (bending the elbow), but
does not always restore full extension (straightening the elbow).
Those patients who come for shoulder replacement
are equally divided between osteoarthritis and rheumatoid arthritis.
The shoulder is a unique joint that it is more dependent on
the function of the muscle groups (especially the rotator cuff)
for its function than is the hip, knee or elbow. If the rotator
cuff is normal, the result of shoulder replacement will be better
than if the rotator cuff is deficient or completely torn altogether.
The status of the muscles can be difficult to completely determine
before surgery, although your surgeon can usually determine
the health of the muscles with his examination of your shoulder
and examination of the x-rays. There are implants under investigation
by the FDA that may offer rotator cuff-deficient shoulders a
better end result. These are not yet available. Fortunately,
relief of the arthritic pain will come even if the muscles are
deficient, but the strength and range of motion will not be
restored. Shoulder replacement patients can return to moderately
strenuous activities around the house or at work, and some sports
activities such as golf. It is important to avoid reaching above
the head as much as possible.
The good news about upper extremity joint replacement
compared with lower extremity is that you can get out of bed
immediately after the surgery and walk wherever you need to
go. For both the elbow and shoulder, a sling is sufficient support.
Exercises begin the day after the surgery. Most patients can
go home in 2 or 3 days. The time to full recovery depends on
individual circumstances, but most patients are very functional
in 2 to 3 weeks, like driving a car. Full recovery can take
as long as 3 to 4 months.
If you have further questions about upper
extremity joint replacement, please call the TCJR office and
speak to one of our staff members.
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