Shoulder replacements are a relatively new procedure. The first widely used shoulder implant became available in the early 1950s and was based on designs for hip replacements. It was very much a one-size-fits-all, Costouros said, with little adaptability for differences in body size. “They didn’t perform very well,” he said. By the 1990s, the parts for shoulder replacements had become more modular, so surgeons could choose the proper size for each patient.
special feature
Looking over the Shoulder How It Works t Its boney structure is simple−the ball at the top of the arm bone, or humerus, and the socket, the curved portion of the scapula, called the glenoid. t It has the widest range of motion of any joint in the body, and so is prone to a variety of unique injuries. t The motion of shoulder is enabled by soft tissue structures: the circular set of muscles that form the rotator cuff provide elevation and rotation of the shoulder; the deltoid muscle; a part of the biceps muscle; ligaments; tendons; joint capsule; and several bursa, fluid-filled sacs that act as buffers between the bones and tendons.
Discovering New Options
In the future, Costouros said, such replacements may be outdated by cellbased therapies to modulate conditions like arthritis. Driesen was hospitalized for just two days after her surgery. “I was progress-
Norbert von der Groeben
The combined improvements, and the introduction of the reverse shoulder procedure, have made shoulder replacements the fastest growing segment of joint replacement types, Costouros said. “In the last 10 to 15 years, we’ve really seen an explosion in our understanding of the anatomy Working with a physical therapist is very important, Costouros and biomechanics of the shoulder, said, “because of the complexity of the shoulder, it can be predisposed to stiffness. It’s important to work with a therapist better surgical techniques, and throughout the different phases of recovery, which usually things that happen at the motake three to four months.” lecular level,” he said. “Because of that, we’ve been able to design ing so quickly and I was off all pain better implants and better implantation medications after 10 days,” she said. methods. Outcomes and longevity of “I’ve had no pain since then.” She began shoulder implants today are far supephysical therapy, which she said hasn’t rior, enabling patients to obtain predictbeen painful either and continues now able pain relief and function that in past at two months following surgery. “It years was not possible” has increased my range of motion to the point where lying down I can lift my In Driesen’s shoulder, Costouros saw the arm from down at my side to up over kind of deterioration that has become my head and hold my arm straight up well known to occur in older implants. pretty much indefinitely,” she said. “The prosthesis had loosened in the socket, and its plastic showed wear. It had all shifted and migrated due to “Outcomes and longevity of the development of a rotator cuff tear.” shoulder implants today are far Without the surgery, Driesen would superior, enabling patients to have lost more and more function, he obtain predictable pain relief and said, and her pain would have increased. “This procedure really is a life-changing function that in past years was not and dramatic intervention for patients,” possible.” he said.
How It Goes Wrong t Ironically, the more active we are the more likely we are to injure the shoulder. Age is another aggressor against the shoulder as are genetics: Osteoarthritis often affects the shoulder joint. t The most commonly injured part of the shoulder is the rotator cuff, the combination of muscles, tendons and ligaments that provides the shoulder its widest range of motion. Unfortunately, the rotator cuff is sensitive to repetitive motions like pitching a baseball, swinging a tennis racquet, or swimming. Contact sports like wrestling or football, however, often cause sprains, strains, dislocations and occasionally tears of important structures of the shoulder. t Many shoulder injuries can be treated with injections of antiinflammatory medications, physical therapy and activity modification. Surgery might be required if conservative treatment fails or will not cure the problem. Many procedures to repair the shoulder are now possible with the minimally invasive approach called arthroscopic surgery, performed through small incisions and as an outpatient procedure.
– John Costouros, MD, orthopaedic surgeon, Stanford Hospital & Clinics Working with a physical therapist is very important, Costouros said, “because of the complexity of the shoulder, it can be predisposed to stiffness. It’s important to work with a therapist throughout the different phases of recovery, which usually take three to four months.” Even though Driesen’s recovery will continue as she builds back strength in her left arm, she is happy with the improvement. “It certainly has made me more comfortable and more able to do the things I want to do,” she said.
On the left, Driesen’s original shoulder replacement implant; on the right, her reversed shoulder implant, with the ball shape implanted into the glenoid and a new socket at the top of her humerus.
For more information about the reverse shoulder procedure at Stanford Hospital & Clinics, visit stanfordhospital.org/reverseshoulder or call 1.866.742.4811. Join us at http://stanfordhospital.org/socialmedia. Watch the new Stanford Hospital Health Notes television show on Comcast: channel 28 on Mondays at 8:30 p.m., Tuesdays at 3:30 p.m. and Fridays at 8:30 a.m.; channel 30 Saturdays at 10:30 p.m. It can also be viewed at www.youtube.com/stanfordhospital.
Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiovascular care, cancer treatment, neurosciences, surgery, and organ transplants. It is currently ranked No. 17 on the U.S. News & World Report’s “America’s Best Hospitals” list and No. 1 in the San Jose Metropolitan area. Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. The Stanford University Medical Center is comprised of three world renowned institutions: Stanford Hospital & Clinics, the Stanford University School of Medicine, the oldest medical school in the Western United States, and Lucile Packard Children’s Hospital, an adjacent pediatric teaching hospital providing general acute and tertiary care. For more information, visit http://stanfordhospital.org/.
April 18, 2012 N The Almanac N 13