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Common Barriers to Having Shoulder Replacement Surgery

In this article, Dr. John Sperling discusses some of his thoughts regarding the most common reasons people living with shoulder pain delay treatment. 

There are a number of potential reasons why patients who could benefit from shoulder replacement surgery have not had the surgery performed. This article attempts to address some of the most common reasons, or barriers, that keep some patients from seeking treatment for their arthritic shoulder pain.

The underutilization of shoulder replacement surgery is unfortunate because the pain associated with shoulder arthritis frequently has two common qualities that make living with it very difficult… shoulder arthritis is progressive and relentless for many people.  

One of the most common complaints reported by patients with arthritic shoulder pain is difficulty sleeping at night due to the pain. Shoulder arthritis will not improve on its own. Without treatment, like shoulder replacement, the pain associated with shoulder arthritis can become progressively more severe. Therefore, being informed about some of the frequent barriers associated with undergoing shoulder replacement is important. 

Three common barriers to shoulder replacement surgery

1.   Pain after shoulder replacement surgery

In the past, shoulder replacement surgery recovery had a reputation of being very painful and very difficult. However, over the past 10 years, through the use of less invasive surgical techniques, improved instruments and implants, as well as multi-modal anesthesia, the recovery has become significantly easier. Multi-modal anesthesia, meaning the use of a variety of different pain relieving strategies, has resulted in more effective pain relief, as well as less side effects from medications. 

These substantial improvements have greatly changed the patient’s pain after the surgery. That doesn't mean that your recovery will be pain-free, and you should talk to your surgeon about a post-operative pain control plan. These changes have been so significant that in the past, many patients spent three nights in the hospital after shoulder replacement surgery. It’s now becoming increasingly common for patients to undergo shoulder replacement as an outpatient procedure. Outpatient procedures are not appropriate for all patients. If you are a candidate for shoulder replacement surgery, talk to your surgeon and insurance company to see if outpatient surgery is right for you.

2.   Living alone

A number of people who have significant shoulder arthritis and could benefit from a shoulder replacement are hesitant to have it performed because they live alone. One of the significant aspects that actually makes shoulder replacement easier in many ways, compared to hip and knee replacement, is that patients can typically walk after the procedure. Patients who have hip or knee replacement who live alone may have challenges with things like stairs. After a shoulder replacement, the operative arm may be in a sling; however, patients can typically walk around their own homes.

The protocols after surgery have significantly improved where stitches are typically absorbable after a shoulder replacement and don’t need to be removed, saving a trip to the doctor’s office. Moreover, many surgeons prescribe a home-based therapy program where patients don’t even need to travel to a therapist and can do the therapy on their own at home. Of course, you may still need help reaching, lifting and carrying things, and patients may need help with some things like washing their hair, or taking care of a pet. Often, a loved one or friend can help with these tasks while you heal. Talk to your surgeon about any restrictions you may have after surgery, so you can plan for any needed help at home.

Another area that has been helpful is that patients are usually taught to put the sling on top of their clothes. This allows patients to take their sling on and off on their own. Many surgeons also give patients an extra sling to wear in the shower. Patients can thus manage everyday activities much easier than was possible in the past.

A home based physical therapy program, absorbable stitches, and being able to take on and off the sling have made the procedure much easier for patients who live alone.

3.   Primary care physicians may not be informed about all of the benefits of shoulder replacement

Another area that has been helpful is that patients are usually taught to put the sling on top of their clothes. This allows patients to take their sling on and off on their own. Many surgeons also give patients an extra sling to wear in the shower. Patients can thus manage everyday activities much easier than was possible in the past.

A home based physical therapy program, absorbable stitches, and being able to take on and off the sling have made the procedure much easier for patients who live alone.

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