Shoulder Arthritis

with R. Sean Churchill, M.D., Advanced Healthcare

Last Updated: July 1, 2003

A shoulder replacement (arthroplasty) often is successful in relieving chronic joint pain. This procedure may be recommended if arthritis or degenerative joint disease makes your shoulder stiff and painful.

R. Sean Churchill, M.D. - Orthopaedics Fellowship Trained, Shoulder and Elbow Surgery, Advanced Healthcare "My patients are up the same day, walking to the bathroom or around the hospital. They go back to their regular home, not to a nursing home. Most find they are off pain medication and have more function within seven to 10 days after surgery."

R. Sean Churchill, a Fellowship-trained orthopaedic surgeon with Advanced Healthcare, is one of two surgeons in Wisconsin who specializes in shoulder replacement surgery.

The majority of his patients have already tried anti-inflammatory medications, physical therapy, and such behavioral modifications as lowering shelves so less reaching is required, but the pain persists.

"Most of my patients complain of a constant aching pain throughout the day that becomes worse at night. Many of them can’t sleep at night or do such simple tasks as scratch their head or comb their hair, some for a number of years," Dr. Churchill said.

Risks and benefits
Dr. Churchill stressed that the arthroplasty procedure can be done on patients of any age and that he has operated on people in their 90s with excellent results. His older patients have likely had a hip or knee replacement or know of someone who has, he said. "I ask them ‘how was their experience with that’ and they say, ‘oh, it changed their lives.’ That puts them at ease about having their shoulder replaced."

Because the surgery is not being done on a weight-bearing joint, recovery is much faster. For those with heart or other conditions that make surgery risky, the operation may be done with local anesthesia, allowing for fewer complications. Patients are up and walking the same day, and sent home two days later with instructions for independent physical therapy, which usually lasts about three months. Usually, no further therapy is needed.

"It’s rare that anyone would be too sick to undergo the procedure," Dr. Churchill said. Since the artificial shoulder joint does not have the same wear and tear as artificial knees or hips, candidates for a shoulder replacement are advised not to wait until they are incapacitated to have the procedure done.

Complications after shoulder replacement surgery occur less frequently than with other joint replacement surgeries. However, there are risks. Infection, intraoperative fracture of the upper arm bone or postoperative fractures, postoperative instability and loosening of the glenoid component are the most common complications. Advances in surgical techniques and prosthetic innovations are helping to reduce the occurrence of complications.

Surgical risks are reduced by the speed with which a patient is up and walking following surgery. A few hours after the replacement, a patient will be walking to the bathroom or around the hospital, alleviating muscle atrophy and the risk of developing blood clots in their legs.

When patients are released, usually two days following surgery, they will go directly home — not to a nursing home or assisted living center.

Post-operation physical therapy
Physical therapy begins in the recovery room with passive stretching and moving exercises done with the aid of trained staff. A patient will be given a sling to wear the first day while the local anesthesia wears off. Beginning the second day, the sling is discarded and the patient begins actively using the arm.

Following shoulder replacement, the physical therapy Dr. Churchill prescribes is all done by the patient independently at home.

Patients are instructed on a gentle stretching program to follow for the first two weeks. When they return to the clinic, they will be instructed on two more stretching exercises to do at home. At six weeks, when they come back for a visit with the doctor and therapist, strengthening exercises are begun. The final visit is at three months and usually no additional therapy is required.

"I tell them the one thing they must not do for the first six weeks is a pulling-in maneuver, such as with a car door," he said. And while the replacement joint may feel a bit uncomfortable for the first week, patients can immediately sleep on their side without fear of injuring their shoulder.

Better than new
Dr. Churchill said that most of his patients find that their new shoulders are more functional than the old ones within two to three weeks after surgery, though that time can vary.

"I had one patient who had been a milkman for 40 years who had beaten his shoulders badly. I fixed his one side and in two weeks that was already his dominant side. He asked when he could get the other side replaced. I told him in three months. Three months and one day later, he was getting the other shoulder replaced. A few weeks after his surgery, his wife came in and hugged me. He’d slept in bed with her for the first time in over five years."

Why a specialist is important
Dr. Churchill is one of two shoulder and elbow trained surgeons in Wisconsin. As a result, he does a number of these procedures every month, while other orthopaedic surgeons may see only a few a year.

"You wouldn’t think of having a hip replaced by someone who does just three a year. You want someone who does three a week," the doctor said. "It should be the same with shoulders, too. But the most important thing for people to understand is that you don’t have to live with that shoulder pain ... there are treatment options available."

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