Gabriel Speros, Tucker Tyler, Boin Michael A
Kansas City University/HCA Midwest Orthopedic Surgery, Orthopedic Surgeons, Inc., Kansas City, MO, USA.
Ann Jt. 2023 Apr 30;8:16. doi: 10.21037/aoj-22-43. eCollection 2023.
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.
A database search of PubMed and Google Scholar was conducted including studies relating to painful shoulder arthroplasty evaluation, management, and treatment.
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.
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.
在过去二十年中，肩关节置换术的普及率显著上升，超过了全髋关节置换术和全膝关节置换术。全肩关节置换术（TSA）已被证明能显著改善大多数患者的功能并减轻疼痛，然而，据报道，解剖型肩关节置换术的并发症发生率超过10%，反向肩关节置换术的并发症发生率为10% - 47%，这些并发症会导致肩部疼痛。随着初次肩关节置换术数量的增加，疼痛性全肩关节的发生率以及翻修肩关节置换术的需求也将呈现类似趋势。对于不断增加的这类患者群体，骨科医生对术后肩关节置换术疼痛和并发症的管理将更为重要。肩关节置换术后疼痛的潜在来源多种多样，包括感染、植入物相关并发症、血肿、神经损伤、肩袖功能障碍、不稳定、骨折以及其他不太常见的并发症。疼痛性肩关节置换术的治疗方案因疼痛来源而异，因此早期识别病因将有助于加快并进行适当的最终治疗。本叙述性综述的目的是强调TSA术后疼痛的常见原因，为外科医生提供处理疼痛性全肩关节的算法方法，并讨论每种疼痛来源的治疗方案。
对PubMed和谷歌学术进行数据库搜索，纳入与疼痛性肩关节置换术评估、管理和治疗相关的研究。
本综述对非感染性疼痛性肩关节置换术进行了深入评估，为每种疼痛来源提供了治疗方案，旨在帮助执业医生管理术后疼痛性肩关节置换术。
随着TSA手术数量的增加，全面了解潜在并发症及其治疗方法至关重要。对疼痛性TSA进行系统评估有助于更快速地识别症状来源。了解常见并发症及其具体原因有助于外科医生避免出现疼痛性TSA。当不可避免地遇到疼痛性TSA时，这些知识也将有助于成功治疗。
