The Shoulder and Elbow
As long as they’re working properly, you probably don’t give your shoulders or elbows much thought. However, injuries, aging and overuse can give you problems with these joints, making you realize how hard they normally work. Virtually every time you move your arms, you’re using both your shoulder and elbow joints.
The shoulder has three main bones – the upper arm bone, the collarbone and the shoulder blade – which fit together in a ball and socket joint. The elbow connects the two bones of the forearm to the upper arm bone in a joint that allows for bending and rotation.
Common Conditions and Treatments
Shoulder or elbow injuries may result from fractures of the bone or injuries to the tendons, ligaments or muscles around the joints. Symptoms of shoulder problems may include pain, swelling and bruising, weakness, instability or stiffness, or a grating, popping or clicking sound.
Sports (such as golf or tennis) or household activities may cause stress and injury to the shoulder and elbow over time. Overuse injuries may include bursitis, tendonitis (such as tennis elbow) or muscle strain. A sudden, more serious injury – such as a dislocated shoulder or elbow, separated shoulder, torn rotator cuff or fracture – may result from a fall, blow to the shoulder or elbow, or abnormal twisting or bending of the arm.
Other possible causes of shoulder or elbow pain include arthritis, muscle tension, calcium deposits in the shoulder joint, an infection, or a herniated disc in the neck. A pinched nerve or heart problem also can be causes of elbow pain.
Treatment for elbow and shoulder pain depends on the nature and severity of the injury or condition. It may include medication, rest and ice, physical therapy, and occasionally surgery.
The artificial shoulder joint can have either two or three parts, depending on the type of surgery required:
• The humeral component (metal) is implanted in the humerus
• The humeral head component (metal) replaces the humeral head at the top of the humerus
• The glenoid component (plastic) replaces the surface of the glenoid socket
A partial shoulder joint replacement is used when the glenoid socket is intact and does not need to be replaced. In this procedure, the humeral component is implanted, and the humeral head is replaced.
The decision to have total elbow replacement surgery should be made carefully after consulting your physician and learning as much as you can about the elbow joint and surgery.
In total elbow replacement surgery, an artificial hinge made of metal and a durable plastic material is inserted into the joint so the elbow can move without allowing the two forearm bones to contact the humerus. This artificial hinge is called an "implant."
You first will be taken into the operating room and given anesthesia. After the anesthesia has taken effect, the skin around the elbow is thoroughly scrubbed and sterilized with an antiseptic liquid. Then, a tourniquet is applied to the upper portion of the arm to help slow the flow of blood.
An incision about six inches long is then made over the elbow joint. The incision is gradually made deeper through muscle and other tissue until the elbow joint bones are exposed.
One of the forearm bones, the ulna, has a projection at the end, which extends up and behind the end of the humerus. A special power saw is used to remove part of this projection. This process allows the two forearm bones to be rotated out of the way so parts of the humerus can be removed. Precision guides are used to help ensure that the cuts are made so the bones will align properly after the implant is inserted.
The arm bones have relatively soft, porous bone tissue in the center. This part of the bone is called the "canal." Special instruments are used to clear some of this soft bone from the canal of the humerus. These instruments also help shape the canal to fit the shape of the implant. Then, similar instruments are used to clear some of the soft bone and shape the canal of the ulna.
The elbow implant consists of two metal stems connected by a metal locking pin. This pin passes through the ends of both stems, which are lined with a strong plastic material, serving as a bearing that allows the elbow to bend. The stems are inserted into each of the two prepared canals. A special kind of cement for bones is first injected into the canals to help hold the stems in place. When the cement is hard, the two implant parts are brought together and the pin is inserted to connect them.
If necessary, the surgeon may adjust the ligaments that surround the elbow to achieve the best possible elbow function. When all of the implants are in place and the ligaments are properly adjusted, the surgeon sews the layers of tissue back into their proper position. A plastic tube may be inserted into the wound to allow liquids to drain from the site during the first few hours after surgery. The edges of the skin are then sewn together, and the elbow is wrapped in a sterile bandage. Finally, you will be taken to the recovery room.
• The artificial shoulder joint can have either two or three parts, depending on the type of surgery required:
• The humeral component (metal) is implanted in the humerus
• The humeral head component (metal) replaces the humeral head at the top of the humerus
• The glenoid component (plastic) replaces the surface of the glenoid socket
A partial shoulder joint replacement is used when the glenoid socket is intact and does not need to be replaced. In this procedure, the humeral component is implanted, and the humeral head is replaced
The decision to have total shoulder replacement surgery should be made carefully after consulting your physician and learning as much as you can about the shoulder joint, arthritis, and the surgery.
In total shoulder replacement surgery, the ball and socket that have been damaged by arthritis are removed and replaced with artificial parts made of metal and a very durable plastic material. These artificial parts are called "implants." They are shaped so the shoulder joint will move similarly to the way the joint moved when it was healthy.
You first will be taken into the operating room and positioned on a special operating table as though lounging in a beach chair. The arm is placed on a board that will allow the surgeon to move it up or down as necessary during the surgery. Anesthesia is given and, when it has taken effect, the skin around the shoulder and upper arm is thoroughly scrubbed and sterilized with an antiseptic liquid.
An incision about six inches long is then made over the shoulder joint. The incision is gradually made deeper through muscle and other tissue until the bones of the shoulder joint are exposed.
The arm is maneuvered until the humeral head is dislocated from the socket. Special precision instruments are then used to remove the damaged cartilage and bone surface from the glenoid, and to shape the socket so it will match the shape of the implant to be inserted. Holes are then drilled into the socket to accommodate the fixation pegs on the implant. These pegs help stabilize the implant
The implant that replaces the socket consists of a durable plastic insert with a smooth, cupped surface. The socket implant is attached by using a special kind of cement for bones. The cement is pressed into the holes. Then, the implant is inserted.
The implant that replaces the ball consists of a long metal stem that fits down into the humerus. A metal head in the shape of a partial sphere is mounted on top of this stem. This head contacts the socket implant in the shoulder blade.
The upper arm bone has relatively soft, porous bone tissue in the center. This part of the bone is called the "canal." Special instruments are used to clear some of this soft bone from the canal. Using a precision guide and saw, the damaged rounded portion (ball) of the humerus is removed.
The metal stem implant may be held in place by either using the special bone cement, or by making it fit tightly in the canal. The surgeon will choose the best method, depending on your age and expected activity level.
If cement is used, it is injected into the canal first, and then the implant is inserted into the canal. If cement is not used, the implant is simply inserted into the canal. On some implants, the stem and partial sphere are one piece. Others, may have separate pieces. If the partial sphere is a separate piece, it is usually secured to the top of the stem after the stem has been inserted.
When all the implants are in place, the surgeon places the new ball that is now part of the upper arm bone into the new socket that is part of the shoulder blade. If necessary, the surgeon may adjust the ligaments that surround the shoulder to achieve the best possible shoulder function.
When the ligaments are properly adjusted, the surgeon sews the layers of tissue back into proper position. A plastic tube may be inserted into the wound to allow liquids to drain from the site during the first few hours after surgery. After the tube is inserted, the edges of the skin are sewn together, and a sterile bandage is applied to the shoulder. Then, the patient is taken to the recovery room.
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