Shoulder Replacement & Manipulation
Total Shoulder Replacement
Total shoulder replacement is a retreading of the shoulder joint in order to relieve pain in arthritis patients. The procedure may also be performed in patients who have rotator cuff tear arthropathy or avascular necrosis, although the doctor will opt for a different approach if the glenoid bone has decayed too much.
In some cases, the surgeon may only replace the ball and leave the glenoid socket untouched, especially if it is still in good condition. The implant itself may be a simple press-fit bone cap if the humeral integrity is good, but may need to use bone cement to ensure attachment if it is not in good shape. If the glenoid socket is indeed replaced, it is usually a complete plastic replica of the area that fits along the chosen ball snugly.
Manipulation under anesthesia (MUA) is a non-invasive procedure that treats acute and chronic pain that has not responded to conventional treatment methods. MUA is also utilized to break up excessive scar tissue by orthopedic surgeons whose patients have not had optimal recovery of their shoulder joint's range of motion (ROM). This multidisciplinary treatment is meant to improve articular and soft tissue movement using controlled release, myofascial manipulation and mobilization techniques. All of this is done while the patient is sedated using monitorized anesthesia care (MAC). The patient may be asleep under general anesthesia, locally numbed through spinal injections or mildly sedated during the procedure.
The patient normally goes through a great deal of testing before this procedure is performed to ensure that they are healthy and to fully observe the area to be treated. This allows for a smooth and safe anesthetizing of the patient and an assurance that they will receive the maximum benefit of the procedure. These exams may consist of:
- Medical history
- Physical exam
- Laboratory exam
- Radiological exam
Shoulder Manipulation Process
The actual MUA treatment consists of a series of stretches and artificial articulation of the patient's shoulder joint through its full range of motion. Low intensity, repetitive stretching helps to break the mold of internal scar tissue that restricts movement. In other cases, high impulse velocity thrusts may be performed to break barriers on movement and naturally release scar tissue, reduce joint restriction and stretch shortened muscle fibers.
The patient will find an immediate increase in mobility following the procedure, but will likely feel drained and sore as if he or she had just undergone a strenuous exercise session involving the shoulder area. Physical rehabilitation should begin as soon as possible, with as active a program as is admissible by the patient. Rehabilitation programs may include electrostimulus, ultrasound, heating and massage.
What is Shoulder Manipulation Used to Treat?
Shoulder manipulation is most frequently employed to treat frozen shoulder, which is also known as adhesive capsulitis. This is a common condition that causes pain and stiffness in the shoulder as a result of a tightening or thickening of the capsule that protects the structures of the shoulder. Although the specific cause of this condition is not known, it most often occurs after recent immobilization of the joint or as a complication of diabetes. Frozen shoulder most often affects patients between the ages of 40 and 60.
Patients with frozen shoulder often experience pain, stiffness and limited range of motion that gradually worsens as the joint becomes more and more frozen. Eventually, the shoulder will shift into its thawing phase, during which pain and stiffness subside and range of motion is slowly restored.
Dr. Williams can diagnose frozen shoulder after a thorough evaluation of your condition, as well as an X-ray or MRI examination, which helps rule out other possible shoulder conditions.
Treatment for frozen shoulder begins with managing pain and other symptoms as the condition progresses. This may include anti-inflammatory medications, corticosteroids and physical therapy. However, your doctor may opt for a minimally invasive surgical procedure, such as shoulder manipulation, with a goal of stretching or releasing the contracted joint capsule. It is considered a sort of middle ground to break up scar tissue without an invasive procedure. This also stimulates fluid circulation into the shoulder, which is very helpful in progressed cases of frozen shoulder.
Questions? If you would like more information about Shoulder Replacement & Manipulation or to schedule an appointment, feel free to fill out our convenient contact form or call our office at (212) 606-1855.