T Nation

Shoulder Replacement


#1

Has anyone had or know of someone who has had shoulder replacement surgery?
Due to severe arthritis, I am having my left shoulder replaced in Nov.

Over the last year my lifting has been dramatically limited as I cannot get my left arm higher than about my chest and it cannot support heavy weights. I am curiuos to how long the rehab will be and what gains (or regains) I can expect. I am 47 and have been lifting & training for over 25 years.
Steve


#2

No answer, but if somebody could also comment on the effects of a hip replacement.....


#3

My doc sent me to a physical rehabilitation hospital to have my left shoulder looked at by a specialist. Over the years (I'm 65, been Olympic lifting for 47 years) I've developed a condition sometimes called "frozen shoulder". That was the diagnosis by the Olympic team physician. The specialist said that I had "end-stage osteoarthritis", based on his assessment of the X-ray images. He recommended a shoulder repalcement (hey, that's what he does for a living). I asked him how much the fake shoulder would hold.
He said, "forty pounds".

Not even a fully-loaded suitcase.

I'm now trying "Dr. Fitt's" inhalant regimen, in addition to some physical therapy to lengthen out the shoulder muscles and get the balance in my two arms back. I expect the inhalant therapy to take a while, but Dr. Mitchell (that's "Dr. Fitt's" real name) is claiming an astounding success rate, and there's an article on using pentosan sulfate in the treatment of osteoarthritis:

     Ghosh P. "The Pathobiology
     of Osteoarthritis and the 
     Rational for the Use of
     Pentosan Polysulfate for its
     Treatment," Seminars in 
     Arthritis and Rheumatism 1999;
     28(4(: 211-267

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#4

didn't preist holmes have his hip replaced ?


#5

Bo Jackson had a hip replacement after damaging the ligamentum teres which supplies the head of the femur with blood. He was able to play baseball, but not like before.
The following is just my opinion, it cannot take the place of an evaluation by a medical professional who can actually see and touch your shoulder.

The problem with replacing a shoulder or a hip is that the more mobile a joint is, the less stable it is. When you start opening up the joint and replacing things, it is a challenge to get stable range of motion back.

With the shoulder replacement, I would get several opinions and ask questions about the surgical approach and if the musculature of the shoulder will be left intact. Are they going to replace the head of the humerus and the glenoid? Or just the head of the humerus? If the shoulder musculature is left intact and you religiously rehab the shoulder then you should be ok. It won't ever be like it was, but a 40# limit it pretty cautious.

If one or more of the the rotator cuff muscles are not left intact then you will have problems. Ask about trying therapy first. If it was a member of my family, I would try as many conservative measures as I could before going under the knife.

In my experience Muscle Activation Techniques would be worth a try. I find it works the best to improve stability and reduce pain whether the cause is arthritis or not. Arthritis generally comes from abnormal joint mechanics over years. MAT helps to normalize joint mechanics and stabilize joints. I have also been trained to use myofascial release. Myofascial release (or any release techniques) can go a long way to improve range of motion and pain, but very often that range is not as stable as it should be. MAT can improve your range of motion and the stability within that improved range.

For example, I have a patient right now whose orthopedic surgeon recommended a shoulder replacement and she is functioning fine. Her pain free range of motion has improved significanlty, but more importantly, her stability is good. I also had a patient who had severe arthritis of the thumbs, touching the thumb to the pinky was impossible due to pain. She had been this way for five years and was at the end of her rope. Her ortho recommended removing the trapezium bone on both sides.

He was then going to take a tendon graft from each forearm and loop it from the thumb to the index finger to create stability in the new joint surfaces. YIKES! She opted to see me instead. After six treatment sessions she was able to return to gardening, riding a bike, writing, etc without pain or instability. If you want more info., you can send me an email or PM. Hope this helps.


#6

I had a full shoulder joint replacement.

Your first issue is whether to have it done. Both of my shoulders were injured in 1980 with multiple trauma fractures from an accident. There were no problems until pain appeared in 1990. The doctors wanted to replace my shoulders. I decided surgery would be my last course of action because it is irreversible. I told them to help me through the pain syndrome, and I would have the replacement if the pain continued or the use of my arms became too limited. I took medication (anti-inflammatory, I believe) for about a month. The pain disappeared and didn't return for ten years, when I decided it was time for the replacement.

Be meticulous about the surgeon you select. I see you're in NYC. Look into Columbia-Presbyterian. Avoid NYU or Hospital for Joint Diseases. Don't go by your internist's recommendation unless he's with a good (teaching) hospital.

Rehab is slow and primarily light resistance exercises to restore the muscles which have atrophied.

You will be strongly advised to cut back or discontinue weight-lifting right away. Anything which causes the bone to grind against bone will worsen the arthritis. A shoulder replacement will not give you an OK to lift weights. Two reasons:
- If you are having a full-joint replacement, the shoulder will be held in place by a spike which will be inserted into your arm. If you lift too much weight, you'll be placing 1/2 the impact on the spike, which is held in place only by the surrounding bone in the arm;
- Shoulder replacements have a limited lifespan. You will probably have to have it replaced in twenty years. The more use and resistance you subject it to will increase the number of additional replacements you will need in your lifetime.

My guess is that you could return to the gym, but only with light high-rep exercises. Even going heavy on other bodyparts would necessitate handling heavy weights and strain the shoulder.

Lou Messina