الفهرس 
Anatomy of Glenohumeral JointOnly 14 pages are availabe for public view
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Abstract
Rheumatoid Arthritis is an inflammatory arthritis caused by an abnormal immune system response against the body’s joints. Severe inflammation in the joint lining causes cartilage breakdown. It accounts for less than 10% of cases of shoulder arthritis and typically affects people in their early 50s (usually women).
Shoulder rheumatoid arthritis typically presents with slowly progressive pain and stiffness. Early on, the pain is usually activity related, but as the joint degeneration becomes more advanced , people may experience pain at rest and pain at night that awakens them from sleep. Roughness of the joint surfaces produces grating and grinding of the bones. Inflammation in the joint lining and pain both result in loss of motion. Progressive stiffness eventually limits shoulder function and thereby may cause muscle weakness and atrophy from disuse. A vicious cycle develops where pain leads avoidance of motion which leads to increased muscle tightness which leads to stiffness which leads to further pain and so on.
A physician diagnoses shoulder rheumatoid arthritis by reviewing the patient’s history , performing a thorough physical examination of the joint and taking the proper X-rays. The examination of an arthritic shoulder reveals stiffness and roughness of the joint. X-rays of the shoulder reveal the contour of the joint surfaces and the status of the cartilage space between them. X-rays of an arthritic shoulder usually show a narrowing of the space between the ball and socket-often to the point that bone is touching bone. These findings indicate that the normal cartilage has been destroyed. X-rays do not show the soft tissues, such as scar tissue, that may also be limiting joint motion. MRI and CT may be done. It is essential that the shoulder surgeon establish the diagnosis of rheumatoid arthritis before shoulder joint replacement is considered.
Surgery is indicated primarily for pain that interferes with a patient’s quality of life. If you can still get by with everyday activities and tolerate or manage the pain with conservative measures, then non-operative treatment is preferred. When these treatments fail, surgery is usually the next step. Surgery is most successful when patients are otherwise in good health or have other medical conditions which are stable and being appropriately managed. In addition, patients should be motivated to succeed as this motivation is critical to the postoperative recovery. Because recovery involves extensive rehabilitation , patients must be mentally and physically ready to commit the time and effort to the process.
Total shoulder replacement surgery (arthroplasty) helps restore comfort and function to the shoulder joint damaged by rheumatoid arthritis by balancing the muscles and replacing joint surfaces with artificial ones.
Total shoulder arthroplasty is a-highly technical procedure and is best performed by surgical team with experience in this procedure. Such a-team can maximize the benefit and minimize the risks. Each case is individual. The two hours procedure is performed under general or (nerve block) anesthesia through delto-pectoral approach.
The reverse total shoulder prosthesis is the best choice for rheumatoid patients. Reverse total shoulder replacement is used for people who have Completely torn rotator cuffs and the effects of severe rheumatoid arthritis (cuff tear arthropathy), for these individuals, a conventional total shoulder replacement can still leave them with pain. They may also be unable to lift their arm up past a 90-degree angle. Not being unable to lift one’s arm away from the side can be severely debilitating. In reverse total shoulder replacement, the socket and metal ball are switched. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm.
Total shoulder arthroplasty can be associated with a multiple complications, the most common of which include prosthetic loosening, glenohumeral instability, periprosthetic fracture, rotator cuff tears, infection, neural injury, and deltoid muscle dysfunction.
The reverse shoulder prosthesis has shown promising short-term results for the treatment of glenohumeral rheumatoid arthritis with massive rotator cuff tears.
A careful, well-planned rehabilitation program is critical to the success of a shoulder replacement. You usually start gentle physical therapy on the first day after the operation. The patient wear an arm sling during the day for the first several weeks after surgery. You wear the sling at night for 4 to 6 weeks .Patients learn to do their own physical therapy and usually discharged three days after the surgery if they comfortable and have a good range of passive motion . The recovery of strength and function may continue for up a year post operative.
Many thousands of patients have experienced an improved quality of life after shoulder joint replacement surgery. They experience less pain, improved motion and strength, and better function.