Osteoarthritis of the Shoulder Total Shoulder Arthroplasty Vail Valley and Greater Denver
in this tutorial we'll illustrate our technique for total shoulder arthroplasty utilizing an anatomicshoulder prosthesis this technique and system allow the surgeon to replicateeach patient's anatomy by adjusting the inclination angle version and head offset hi, today we're going to talk about shoulder osteoarthritis and demonstratea total shoulder replacement my name is peter miller and we'rehere at the Vail Valley Medical Center our patient is a seventyfour year old a left hand dominantgentleman with long standing shoulder pain
he's failed nonoperative treatment includinginjections in physical therapyand his pain has become progressively debilitating to the point where he has difficulty sleeping atnight he also has restricted passive motion active motion in his shoulder his xrays as you can see here as ana_p_ view of the left shoulder demonstrating some of the classic findingsof osteoarthritis he has goad sphere deformity with an inferior osteophyte hereon the humeral head flattening of the humeral head
he also has subchondral sclerosis and he has some early cysts formation in thejuxtaarticular space in that particular humerous it's always important to get 3Dimaging as well and we get either an MRI or CT scan to look at the shape ofthe glenoid and to evaluate the degree of going to glenoid retroversion that's presenthere's his MRI demonstrating mild retroversion but not severe he does not have a biconcave glenoid. If they have a biconcave glenoid
they usually have to do morework and it's more difficult exposure but this is fairly straight forward somesome retroversion here you see his biceps tendon with a lot of fluid around itthere's a lose body in the back here you see again joint space narrowing and flatteningof the humeral head with some osteophytes anteriorly and posteriorly and his subscapularis looks to beintact so with this case we're going todemonstrate a an anatomical total shoulder replacement go through thesteps to help you do a better total
replacement thank you the patient is positioned in beach chairposition with the assistance of the hydraulic arm holder we utilize a standard deltopectoral approach the incision begins just distal to theclavicle passes over the lateral third of thecoracoid process and continues over the proximal arm full thickness flaps are created with sharpdissection
next, the cephalic vein is carefully dissectedand retracted medialy so as to minimize traction on the vein withretraction the clavipectoral fascia is identified and incised just lateral to the biceps tendon at this point the anterior circumflex humeralvessels are identified and cauterized at the medial boarder of thebiceps tendon to improve exposure the superiorcatchment of the pectorals tendon is released
Shoulder Arthritis Narrated Animation
The main joint of the shoulder is the jointbetween the head of the humerus the upper arm bone, and the glenoid cavity of the scapulathe shoulder blade. This is a ballandsocket type of joint.Shoulder arthritis refers to loss of cartilage on the surface of the humeral head and theglenoid of the shoulder joint. The two bones rub against each other and produce pain, stiffnessand difficulty moving an arm. Types of shoulder arthritis include:Osteoarthritis also called degenerative joint disease is the quot;wear and tearquot; conditionof the joint, commonly due to old age. Osteoarthritis is characterized by loss of cartilage, bonespurring and NO major inflammation.
Rheumatoid arthritis â€“ is a result of inflammationof the synovium the membrane that encloses the joint. Inflammation brings in the cellsof the immune system, whose inflammatory chemicals damage and destroy the joint. It is not clearhow rheumatoid arthritis starts but genetic predisposition together with infection ofthe joint are likely to be among the causes. Rotator cuff arthropathy or cuff tear arthropathyis shoulder arthritis AS A RESULT and IN A SETTING of rotator cuff tears. Rotator cuffmuscles hold the ball and the socket together and prevent the humeral head from moving outof the socket when the person raises an arm. In people with torn rotator cuff, the headof the humerus moves upwards and rub onto
the acromion. This causes damages to the coveringcartilage and eventually arthritis. Combination of cuff tear and arthritis is a devastatingcondition that seriously impairs functions of the shoulder joint.Posttraumatic arthritis â€“ is arthritis that develops after physical injury to thejoint. Chondrolysis sudden loss of cartilage thathappens occasionally after a shoulder surgery, commonly seen in association with infusionof local anesthetics into the joint for pain management.