Way back when, at the turn of the century, the concept of the free lunch was introduced. It was offered by pubs owned by beer companies as a way to entice workers to buy more beer over their lunch hour. It included lots of salty items that went well with beer, prompting the proverbial retort that “there is no such thing as a free lunch.” The concept can also be applied to shoulder replacement surgery. The idea appears appealing—your shoulder joint is worn out, so you go in and get a new part.
Not so fast says a new study, as its findings demonstrate that shoulder replacement recovery generally includes damage to the rotator cuff! This new research found that no matter how the new shoulder prosthesis was arranged and how the rotator cuff muscles were repaired, the muscles never functioned normally. This led the authors to conclude that abnormal forces on the new shoulder could well have a devastating long-term impact on the new joint, which may explain why patients often tell us that their new shoulder isn’t all it was cracked up to be.
To answer that question, we first need to understand the shoulder joint. The shoulder is a very complex ball-and-socket joint that has the greatest range of motion of any joint in the body. To allow for that, its socket is particularly shallow, requiring a very elaborate system of tendons, called the rotator cuff, to keep it in its socket throughout its range of motion. This involves millisecond-timed and millimeter-oriented precision orchestrating the laxity of some ligaments and the tightness of other ligaments that allow the ball to stay in one small region in relation to the socket as you move. The rotator cuff is the most crucial part of this process as it is the greatest concentration of multiple tendons and attachment points. However, there are more instruments in this complex symphony as the strength of the ligaments insure that the humeral head stays in position as you move, and the labrum, which is a cartilage-like lip on the socket, increases the hold on the ball of the joint.
In addition to motion, these tendons, ligaments, muscles, and cartilage keep the bones that make up the shoulder together. The main bones making up your shoulder joint are the humerus, whose head forms the ball that fits into the socket of the scapula (shoulder blade); the acromion, which is a bony projection off the scapula; and the clavicle (collarbone), which meets the acromion and together they make up the acromioclavicular joint. Surgically removing the joint and then getting a metal prosthesis to successfully pair with the orchestration of this complex system without the biologic signals to control force and timing is incredibly difficult. Together with the damage done to the rotator cuff from the surgery itself, it’s easy to understand why these errors in messaging and force so often result in the rotator cuff damage so shockingly associated with shoulder replacement recovery.
Shoulder instability occurs when tendons and ligaments get stretched, torn due to trauma, or simply worn out due to age and cause too much motion in the joint. This additional motion leads to arthritis as sections of the joint are exposed to more wear and tear, bone spurs as your body’s solution to “shoring up” an unstable joint, and tears and stretching of the ligaments as they deal with forces they’re not designed to take. Rotator cuff tears are especially common as when the rotator cuff’s complicated multi tendon millisecond timing is off, damage occurs. So the trick is recognizing and treating instability when it occurs.
The best way to treat shoulder instability and the issues it causes is by using precise injections of your own platelets and stem cells. This will give your shoulder what it needs to heal without the additional burden of the healing required following the trauma from surgery.
We have many different treatment options available to us to treat shoulder issues. Our platelet procedures are often used, but when instability or arthritis is severe enough we take out the big guns and use our patented stem cell shoulder procedure Regenexx Rotator Cuff, which was specially formulated for the unique needs of the complex shoulder joint. When instability is the issue, using specially designed ultrasound, we can track progress over time and tweak if necessary.
The upshot? There is no free lunch here, as the biggest issue in shoulder replacement recovery is, amazingly enough, rotator cuff damage, so you’re going to pay for that new shoulder one way or another! Treat and keep your own shoulder as joints can be amputated and metal prostheses inserted, but they can never truly be replaced!
*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.
Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…