Shoulder Arthritis: Drive Pain-Free Off the Tee

Shoulder Arthritis: Drive Pain-Free Off the Tee

If shoulder pain is affecting your golf game, there is a chance that you may have shoulder arthritis. The glenohumeral joint or shoulder joint is made up of a ball and a socket, and with this ball and socket you have a larger ball and a smaller socket, similar to a golf ball on a tee.

Sometimes, this can be unstable or potentially through injuries you can have damage to the cartilage that lines both the ball and the socket of the shoulder joint. This can lead to glenohumeral or shoulder arthritis. This is when the surfaces become very rough and can even change shape a little bit.

Sometimes, this is described as having sandpaper inside your shoulder or, when shoulder arthritis gets very severe, as having a block in a socket instead of a ball in a socket. This can cause considerable pain and can also make the shoulder become very stiff.

If you are having a lot of shoulder pain and a lot of stiffness, along with creaking or crunching inside your shoulder, there is a chance it is shoulder arthritis. When this happens, you may go and see a health care provider who will likely get x-rays.

Here are some sample x-rays of a shoulder with arthritis. Here, what we see is the ball and the socket are actually very close together. They have been rubbing up against each other, so we see that there is no space between the ball and the socket. We also see a bone spur, as you can see here. This is when the bone has started to change shape because there is no cartilage softening the connection between the ball and the socket in the shoulder.

When you meet with your health care provider after having a full physical examination and x-rays like we showed on a previous screen, if glenohumeral arthritis or shoulder arthritis is the problem, they may recommend injections inside your shoulder, potentially physical therapy, and certainly some activity modifications. Do not do the things that are causing a lot of pain.

If this is concerning for you and the surgeon is recommending having a total shoulder replacement or replacing the ball in the socket joint that has arthritis, recognize that there are a lot of different options out there. Again, this could actually be overwhelming to you as the patient.

The surgeon themselves are not just going into their golf bag and picking out a random ball or random shoulder replacement, they will pick a very specific for the patient themselves. We will go through reasons to pick the anatomic versus a reverse shoulder arthroplasty or shoulder replacement in just a minute.

They picked the shiny one for anatomic total shoulder arthroplasty or anatomic total shoulder replacement. This is an anatomic total shoulder replacement and this is what is called a reverse total shoulder replacement. We will go through each of these individually and highlight the differences in just a second.

With an anatomic total shoulder replacement, we have the wearing away of the ball in the socket. We are going to replace the ball in the socket with metal and plastic. So we put metal on the humeral side, the ball side, and then a combination of metal and plastic or perhaps just plastic on the glenoid to create that socket.

Here, this would restore the normal golf ball on the tee, but in order to keep that golf ball or the humeral head on the tee, keep the shoulder in the socket; we need a good functioning set of muscles right around that. Those muscles are called the rotator cuff, the subscapularis, the supraspinatus, the infraspinatus, and teres minor. These work in concert to help move the arm around the shoulder. However, what is required is all these muscles to be intact in order to have an anatomic total shoulder replacement.

In the United States, there are over 200,000 shoulder replacements every year. This is a combination of the anatomic and the reverse. In addition to the x-rays that we showed earlier, surgeons frequently get a CAT scan or CT scan to better map out the bones. With the aging population, we see more and more shoulder replacements every single year.

Traditionally, there was long stems that were sent down into the humerus bone. Now, we use shorter or even stemless implants like we see here. We have a combination of this cage screw, which secures very well in the bone. This is kind of like hanging a heavy picture on the wall, you'll get much better fixation if you put a screw in to hang that big picture as opposed to a nail.

Over time, the bone will actually grow through those little holes that you see in that screw, making this a very solid implant in the long run. That was the anatomic total shoulder replacement.

Let us talk about the reverse. With the reverse total shoulder replacement, we are actually taking that golf ball and that tee and flipping them around. We are actually putting them on the opposite side. The reason we have to do this is because we have to make sure everything stays stable and give the patient as much motion as they can. Here, we rely on the deltoid muscle since there was some limitation or issue with the rotator cuff muscles we saw in the anatomic shoulder.

With the reverse shoulder, everything is designed around using this large muscle group called deltoid. This will help raise the arm and rotate the arm. It is similar to what someone may get with the rotator cuff in the anatomic total shoulder. These implants are obviously going to look quite a bit different because we are switching things around.

What does that actually look like? We have the same shoulder with worn away cartilage and glenorhumeral or shoulder arthritis. We are going to put the glenosphere or put this rounded ball on the glenoid side, the socket side, and then on the humeral side, we are actually going to put this implant, which is going to be the new socket.

Here, we cut off the humeral head, we put this implant here and then on the glenoid side or old socket side we put the rounded ball. The function of this is like you see in the animation here, the deltoid muscle is going to help raise and lower the shoulder and move it around nicely.

To get these implants in the exact right position surgeons are often using their CT scan and this preplanning software, which shows them exactly where to send their screws, send their pins and do the cutting of the bone. This can get the implants in the exact right position for both an anatomic shoulder replacement and a reverse shoulder replacement like we see here.

Both these types of surgeries require an incision. In order to minimize the chance of infection, many surgeons will use specific bandages to help minimize that. This specific bandage has copper and zinc in it, which helps create like a microcurrent, like a little battery inside the shoulder, to help kill bacteria and minimize the risk of infection.

This all sounds happy and good; maybe you think you are going to walk out of surgery the day of, and you are going to be thinking, what am I going to do now? Get back on the golf course. Recognize that recovery is not that quick. There will be times when you are in pain and you are putting ice on your shoulder. However, over time you will be doing more activities and getting that smile back on your face.

Recognize that it is very important with anyone with shoulder arthritis to get on the same page as your health care providers. Set realistic goals and expectations. Treating a patient with shoulder arthritis is not magic. Every single surgery is unique for both the anatomic and the reverse shoulder replacement.

If the shoulder arthritis has given you a bunker shot, hopefully, you will be able to swing right out of that by having a shoulder replacement whether that be anatomic or reverse. Thank you.