Management of Painful Shoulder Arthroplasty: A Narrative Review

Fossati, C; Vitale, Marianna; Valvecchi, Tommaso Forin; Gualtierotti, Roberta; Randelli, Pietro

doi:10.1007/s40122-020-00186-0

Cited by 8 publications

(10 citation statements)

References 18 publications

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“…Timing of pain can help narrow the differential. Pain at rest may be associated with infection or neuropathic pain, while pain with range of motion and/or activity suggests structural sources of pain, such as component impingement, component loosening, tendinopathy, and fracture ( 2 , 6 ). Time since surgery is a helpful tool in assessing the integrity of components.…”

Section: Evaluation Algorithm ( Figure 1 )mentioning

confidence: 99%

“…Hematoma is seen at a greater rate in rTSA than in aTSA. There can be increased dead space between soft tissue planes in rTSA with many rTSA procedures being performed in patients with poor or torn rotator cuff tissue in combination with a larger acromiohumeral interval due to humeral distalization ( 2 ). Management of this complication is initially with observation.…”

Section: Sources Of Pain In Tsamentioning

confidence: 99%

“…Common indications for shoulder arthroplasty include: osteoarthritis, inflammatory arthritis, rotator cuff dysfunction or deficiency, proximal humerus fracture, and avascular necrosis ( 1 ). Excellent outcomes have been reported with both anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

“…Despite the excellent outcomes of shoulder arthroplasty procedures, residual shoulder pain can occur with complication rates after shoulder arthroplasty reaching approximately 10% in anatomic shoulder arthroplasty and 10–47% in reverse shoulder arthroplasty ( 2 , 3 ). There are a multitude of potential causes of postoperative pain including infection, aseptic component loosening, rotator cuff tendinopathy, instability, fracture, nerve injury, among others.…”

Section: Introductionmentioning

confidence: 99%

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A narrative review of non-infected painful total shoulder arthroplasty: evaluation and treatment

Gabriel¹,

Tucker²,

Boin³

2023

Ann Joint

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Background and Objective The prevalence of shoulder arthroplasty has increased significantly over the past two decades outpacing both total hip and total knee arthroplasty. Total shoulder arthroplasty (TSA) has been shown to significantly improve function and pain in most patients, however, complications after shoulder arthroplasty have been reported to be greater than 10% in anatomic shoulder arthroplasty and 10–47% in reverse shoulder arthroplasty leading to a painful shoulder. As the number of performed primary shoulder arthroplasty increases, the incidence of painful total shoulders and the need for revision shoulder arthroplasty will see a similar trend. Management of post-operative shoulder arthroplasty pain and complications will be even more essential for the orthopedic surgeon in this growing population. Potential sources of pain after shoulder arthroplasty are variable and include infection, implant related complications, hematoma, nerve injury, rotator cuff failure, instability, fracture, among other less prevalent complications. Treatment options for the painful shoulder arthroplasty differ depending on the source of pain, thus early identification of the cause will lead to expedited and appropriate definitive management. The objectives of this narrative review are to highlight the common causes of pain after TSA, provide surgeons an algorithmic approach for working up the painful total shoulder, and discuss treatment options for each source of pain. Methods A database search of PubMed and Google Scholar was conducted including studies relating to painful shoulder arthroplasty evaluation, management, and treatment. Key Content and Findings This review presents an in-depth evaluation to the non-infected, painful shoulder arthroplasty, providing treatment options for each source with the goal of assisting practicing physicians in the management of painful post-operative shoulder arthroplasty. Conclusions With increasing numbers of TSA being performed, a thorough understanding of the potential complications and their treatments is essential. A systematic approach to working up the painful TSA can help identify the source of symptoms more readily. Knowledge of the common complications and their specific causes can help surgeons avoid the painful TSA. This knowledge will also help to successfully treat the painful TSA when it is inevitably encountered.

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Section: Evaluation Algorithm ( Figure 1 )mentioning

confidence: 99%

Section: Sources Of Pain In Tsamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A narrative review of non-infected painful total shoulder arthroplasty: evaluation and treatment

Gabriel¹,

Tucker²,

Boin³

2023

Ann Joint

View full text Add to dashboard Cite

show abstract

“…Multiple studies have elaborated on potential etiologies of pain specific to RSA, which include instability, scapular notching, acromial/scapular spine fractures, and anterior shoulder pain/subcoracoid pain. 7 , 9 , 11 Anterior shoulder pain after RSA is not well defined. It has been postulated to be secondary to coracoid fracture, 2 subcoracoid adhesions in the setting of multiple surgeries causing stiffness, excessive distalization of the humerus leading to tendinitis of the biceps brachii and coracobrachialis tendon, 24 and subcoracoid impingement due to the abutment of the humeral prosthesis.…”

mentioning

confidence: 99%