You may be considering shoulder replacement surgery if you suffer from life-limiting shoulder pain that doesn’t respond to non-operative treatments. The procedure helps relieve pain, improve function and increase your comfort with daily activities.
While it can significantly enhance your quality of life, you may still have reservations about shoulder replacement and its impact on your lifestyle. Dr. Michael Bender, a shoulder and elbow specialist at Forté, breaks down the three phases of the rehabilitation process so you know what to expect from the recovery timeline.
0-4 Weeks: Protective Phase
For the first four weeks after surgery, you’ll be in the protective phase of rehabilitation. The main goals of this phase are as follows:
During this phase, physical therapists will guide you through gentle stretching exercises to help prevent stiffness.
“There is often less pain following shoulder replacement than other joint replacements, such as the knee, but functionality is limited,” says Bender. “During the first phase of rehabilitation, you won’t be allowed to lift and raise your arms, but you can use your hands for writing, typing, cutting food and other similar activities.”
Sleep is typically the most challenging part of the protective phase, with side and stomach sleepers often having the hardest time adjusting.
“It’s okay to sleep on your back, so patients often prop themselves up with bed pillows, a wedge pillow or use a recliner,” says Bender. “Prior to surgery, it’s not a bad idea to practice sleeping on your back if you’re not used to doing so.”
1-3 Months: Mobility Phase
From one to three months after surgery, you’ll be in phase two of the rehabilitation process. Your shoulder should be less painful than it was before the procedure, and your focus will be on three main areas:
“You’ll be able to get dressed, raise your arm to reach items and other everyday stuff, but we’re still protecting the repaired tendon,” says Bender. “Once the tendon is fully healed, it’s extremely unlikely that you would have any setbacks. That’s when we can get more aggressive with physical activities.”
3-6 Months: Strengthening Phase
From three to six months post-op, you’ll be in the final phase of your rehabilitation and can focus on increasing the strength of your shoulder.
“The vast majority of patients return to sports and other physical activities somewhere between four and six months,” says Bender. “At this point, the shoulder is typically strong enough to do the things they want, such as golf, pickleball and swimming.”
While some surgeons may restrict physical activity, Bender believes your shoulder will let you know what it can handle.
“We provide general guidance so that patients understand really intense activities or powerlifting could wear out your implants sooner, but these are big picture guidelines and not strict instructions or restrictions that would be the same for all patients,” he says. “The motion, strength and function gained in therapy will help determine what its capable of.”
Setting Realistic Expectations for Your Recovery Timeline
While many patients fully recover from shoulder replacement surgery in four-six months, many factors can affect the recovery timeline, such as:
Still, total shoulder replacement is an effective procedure, with most patients returning pain-free to sports and daily activities.
To schedule a consultation with one of our shoulder replacement physicians, call 317.817.1200.
More resources for you:
Shoulder replacement is the third most common joint replacement surgery after knees and hips. The procedure is a reliable option for reducing pain and improving function in your shoulder.
You may be considering shoulder replacement surgery if you…
• Have severe arthritis pain that prevents you from participating in daily activities.
• Experience pain while resting, especially if it interferes with sleep.
• Have limited range of motion and/or hear a crunching, grinding or ratcheting sound with movement.
• Tried less invasive options such as medication, injections, physical therapy and/or adjusting your activities with little to no results.
Below, we look at three types of shoulder replacement surgeries and what makes them most effective.
The Anatomy of the Shoulder
First, it’s important to understand the parts that make up the shoulder, which is a ball-and-socket joint. The ball (head) at the end of your upper arm bone fits into the socket formed by your shoulder blade.
In a healthy shoulder, the areas where the ball and socket meet are covered with cartilage. This cartilage helps protect the bones and enables them to move smoothly. The shoulder bones are surrounded by muscles and tendons, which help promote stability and support your movement. This structure is important because the shoulder joint has the greatest range of motion of any joint in the body.
All shoulder replacement surgeries involve removing damaged areas of bone and resurfacing them with metal and plastic implants.
Partial Shoulder Replacement (Hemiarthrophsty)
In a partial shoulder replacement (hemi) surgery, only the ball side of the joint is resurfaced with an implant. While it’s the least common shoulder replacement performed today, a partial may be recommended if only the ball side of your shoulder joint is damaged or injured.
A partial replacement preserves more bone than other shoulder replacement surgeries, but it does not typically provide the same pain relief or last as long as other procedures.
Primary (Anatomic) Total Shoulder Replacement
Most shoulder replacement surgeries are primary total shoulder replacements, also known as anatomical total shoulder arthroplasty (TSA) replacements. Unlike a partial, both the ball and socket sides of the joint are resurfaced with implants. As the name suggests, these implants closely resemble the natural shapes of your bones.
In an anatomical TSA replacement, a surgeon fits your upper arm bone with a new metal ball, which will become one with the bone over a few months. A plastic liner is attached to the socket side of the joint. The implants are smooth and will not hurt when you move and use them.
You and your surgeon may discuss anatomic shoulder replacement if you have severe arthritis and your tendons remain intact.
“Prior to an anatomic replacement, we want to make sure your tendons and muscles are working properly and that you have plenty of healthy bone to work with,” says Dr. Michael Bender, a shoulder and elbow specialist at Forté. “Our goal is to restore your shoulder to as close to normal as possible.”
Reverse Total Shoulder Replacement
Patients with a torn or severely weakened rotator cuff tendon cannot have a primary total shoulder replacement. These patients may be better candidates for a reverse shoulder replacement.
A reverse procedure also involves resurfacing both sides of the joint, but the position of the implants is reversed. The ball is attached to your shoulder blade, and the plastic socket liner goes at the end of your upper arm bone.
This type of surgery is a good fit for patients with chronic or acute rotator cuff tears because they don’t need full use of their shoulder muscles and tendons for it to work long-term. You may also be a good candidate for a reverse procedure if you have arthritis with rotator cuff tears, a socket that is too worn /deformed, a severe shoulder fracture or as a revision of a prior shoulder replacement.
“The reverse procedure isn’t as good at restoring function as an anatomic replacement would be, but it’s a better range and quality of movement than the patient would have had,” says Dr. Dale Snead, an upper extremity injury specialist at Forté. “This procedure is designed for pain control, and a majority of patients have significantly less pain than they did before surgery.”
Deciding Which Surgery Is Right for You
Your surgeon can help you understand which type of shoulder replacement surgery would be most appropriate for you.
To schedule a consultation with one of our joint replacement specialists, call 317.817.1200.
You can also check out our many resources for shoulder replacements:
• How shoulder replacement is evolving with better implants and patient-specific surgical planning.
• Three steps that will help prepare you for shoulder replacement surgery.
• See how long it takes to recover from shoulder replacement surgery.
• Take a deeper dive into reverse shoulder replacement surgery.
Advances in medical technology and surgical techniques have made total shoulder replacement one of the most successful orthopedic surgical procedures performed today, with primary (anatomic) shoulder replacement being one of the most common shoulder replacement surgeries.
As Forté shoulder and elbow specialist Dr. Michael Bender explains, the procedure only continues to evolve with better implants and patient-specific surgical planning.
Anatomy of the Shoulder
The shoulder is a ball-and-socket joint with a ball (head) at the end of your upper arm bone that fits into a shoulder socket formed by your shoulder blade. A primary total shoulder replacement surgery involves removing the damaged portions on both sides of the joint and resurfacing them with similarly shaped metal and plastic implants.
Innovations Result in Better Implants
Historically, the implant for the ball side of the joint included a long stem (rod) that was inserted into your upper arm bone. Recent design innovation has led to a less-invasive option, known as a “stemless” implant, that is fixed to the bone with pins and cement.
The stemless design has several benefits, including:
The majority of primary total replacement surgeries performed at Forté involve stemless implants.
“We can put a stemless implant exactly where it needs to be to match your anatomy,” says Bender. “It’s a more personalized shoulder replacement, which can reduce the risk of implant malpositioning which should lead to better range of motion, less stress on the rotator cuff and faster recovery.
Additionally, the plastic liner implanted on the socket side has evolved to have better wear properties, vitamin E impregnated to reduce free radicals that cause break down and better methods of fixation to the socket to limit loosening. It’s also more customizable than previous versions and can help correct bone deformities. This personalization has expanded the pool of patients eligible for primary total shoulder replacement surgery.
“You have a limited amount of bone on your socket for us to be able to correct,” says Bender. “In the past, we had to tell patients with certain bone deformities there was nothing we could do for them. The evolution of the augmented implants enables us to build back up the joint to correct it, and it makes the procedure a viable option for more patients with bone deformities.”
Advancements in Surgical Planning
Another advancement in primary total shoulder replacement is the development and utilization of patient-specific 3D surgical planning software. At Forté, a CT scan of your shoulder results in a virtual model of your joint that is used to simulate the surgery. During the simulation, surgeons can determine:
They can also generate a 3-D printed patient-specific guide to help them align the implants during your shoulder replacement surgery.
“Technology has improved not only how we plan for surgery but also how we execute it,” says Bender. “The customized guide shows us the exact angle we need to carry out the replacement exactly as we planned it.”
Reducing the Margin of Error
Together, advancements in surgical planning and implant design are reducing the margin of error in primary total shoulder replacements.
“It’s exciting to be at the forefront of these new technologies and techniques to improve this procedure better for our patients,” says Bender.
If you’re ready to take the next step, our joint replacement specialists can provide the latest technology and techniques for the best results and fastest recovery. Call 317. 817.1200 to schedule a consultation.
More Resources for You:
Shoulder replacement is surgery to remove damaged parts of your shoulder joint and resurface them with smooth metal and plastic implants. Due to advancements in technology and surgical techniques, it’s more effective than ever at relieving pain and improving function in your shoulder joint.
As with any surgery, adequate preparation can help ensure the best possible outcome. Dr. Michael Bender, a shoulder and elbow specialist at Forté, walks us through three important steps of the pre-operative process and explains how they ensure you and your surgical team are prepared for your procedure.
Step 1: Patient-Specific Surgical Planning
First, Forté surgeons utilize new technology for surgical planning that helps personalize every total shoulder replacement surgery. During the pre-op process, they perform a surgical simulation using a virtual model of your joint that is generated from a CT scan.
This enhanced surgical planning helps your surgeon determine the following:
Your surgical team can also use the software to create a 3-D printed customized guide (when necessary) to help align the implants as planned during your surgery.
Step 2: Individualized Assessment
Before your surgery, you’ll also meet with the in-house pre-operative medical team for an individualized assessment to ensure your experience is as safe as possible. You’ll receive information on how to prepare for your surgery, such as:
The pre-op team will review your medical, surgical and family history and conduct a physical exam. They may order blood tests, urine tests and an EKG, which is a scan of your heart.
The pre-op team’s job is to ensure every patient is fit for surgery and outline a personalized plan for their recovery.
“They will determine who’s safe to go home the day of their surgery and who should be observed overnight to ensure there are no bumps along the road to recovery,” says Bender.
Step 3: Rehabilitation Education
Finally, you may participate in a one-on-one session with Forté’s physical therapists. Recovery from shoulder replacement surgery can take up to four-six months and will include several phases of rehabilitation. Receiving education prior to your procedure can help you set realistic expectations for your journey.
“After your surgery, you’ll be in a sling for about four weeks,” says Bender. “Patients have questions about how they will drive, shower, get dressed, eat and change their clothes. During an educational visit, a physical therapist will share tips and tricks to help make the start of the rehabilitation process as smooth as possible.”
Still have questions about what to expect before and after shoulder replacement surgery? Check out our many resources for shoulder replacements:
To schedule a consultation with one of our shoulder replacement specialists, call 317.817.1200.
Few actions in sports create more drama and excitement than the final pitch or touchdown throw. From youth sports to the pros, you can probably picture it now – a throw that won or lost the game, leading to jubilant celebrations or devastating disappointment.
Throwing requires an explosive and highly coordinated movement involving the whole kinetic chain, from the toes to the fingertips. While throwing builds suspense in sports, it also exposes athletes to a specific set of injury risks.
According to Forté’s Dr. Michael Bender, head team orthopedic physician for Butler University Athletics and Park Tudor School in Indianapolis, evidence shows the most significant risk is overuse.
Overuse: The Number One Risk
Overuse injuries occur when athletes experience repetitive stress to the body without allowing adequate time for the body to heal.
“There are a lot of factors that can increase the risk of overuse for young throwing athletes,” says Bender. “The big push for year-round baseball puts pressure on kids to join travel leagues and have extra training.”
“Kids can throw too many months of the year or too many pitches or innings per game,” he continues. “They can more easily violate pitch count recommendations because they’re on multiple teams and other coaches don’t know how much they’re pitching or what positions they’re playing.”
Athletes who experience a high volume of throws combined with inadequate rest and recovery can suffer from rotator cuff issues, labrum injuries, growth plate injuries, ulnar collateral ligament (UCL) tears in the elbow and more.
“Parents, athletes, coaches and trainers should be proactive about monitoring workload more than anything,” says Bender. “Athletes can still train, get stronger and develop other parts of their game, but they need time off for their arm to recover.”
Throwing When Fatigued
The repetitive and forceful nature of throwing can also cause fatigue, the second greatest risk of injuries to throwing athletes. When muscles become fatigued, there is extra stress on vulnerable ligaments, which can lead to tears.
“We see this most often in those pitching while fatigued,” says Bender. “Those who do it regularly can have up to 36 times the injury risk.”
In addition to providing sufficient rest periods, coaches can help prevent fatigue-related injuries by developing strength and conditioning programs and gradually ramping up training intensity, especially for those returning from an injury.
High-Velocity: Putting Stress on the Body
A third leading risk factor for throwing athletes is velocity. The harder they throw, the more stress they put on their bodies, which can lead to muscle strains, tendon ruptures and ligament tears.
“High-velocity pitches get really close to the max of what ligaments can withstand,” says Bender. “We want the velocity gains to come from your lower half and whole kinetic chain to be more efficient in how you throw.”
To help avoid velocity-related injuries, athletes and coaches should focus on developing good hip and core strength to produce power.
Minimizing the Risks
While throwing can lead to various injuries, the good news is that many are preventable.
Athletes, coaches, parents and trainers who understand the greatest risks of injuries and what causes them can better protect a throwing athlete’s overall health and performance.
“We’re not trying to bubble wrap our kids,” says Bender. “We know there will always be some risk in sports, but we want to figure out how to make it fun and enjoyable while also minimizing those risks."
Forté offers services to help throwing athletes prevent and manage injuries. Its Throwing Athlete Program provides tailored rehabilitation, sport specific training and screening services specific to the overhead athlete. Request an appointment by phone at 317.812.1200.
These recommendations have been excerpted from Coaches Corner, a free monthly webinar series for coaches, athletic directors and athletic trainers. The series, developed and presented by Forté, in partnership with IHSAA, aims to arm coaching and support teams with helpful information to consider when working with their athletes. Subscribe online so you don’t miss an episode.
Today in the United States, baseball and softball are extremely popular, with about 15 million kids participating annually in “America’s Favorite Pastime.”
Many of these young athletes dream of reaching the next level – high school, college or even the major leagues. While the quest for a competitive edge can prove fun, it also requires athletes to perform unique and taxing endeavors, such as throwing repeatedly as hard as their bodies can do it.
“Throwing involves a highly coordinated and explosive movement that incorporates the whole kinetic chain, from their toes to their fingertips,” says Forté’s Dr. Michael Bender, a former assistant to the Houston Astros team physicians who is now team physician for Butler University. “It puts a ton of stress on the body.”
Historically, baseball and softball coaches have tried to minimize this stress by delaying the addition of specific pitches, such as a curveball, to a young pitcher’s repertoire. The thought was that the complex pitch would put too much stress on a developing arm.
Bender says the data proves otherwise.
“The truth is that there’s actually less stress on the shoulder and elbow when throwing a curveball than a fastball,” says Bender. “It’s been ingrained in many people that you shouldn't throw curveballs until puberty, but there really isn’t good evidence against it. Studies don't show an increased risk of injury in those who throw curveballs at a young age.”
The key, he says, is understanding when an individual can safely put together the speed, spin and location precision necessary to deliver a curveball across the plate. Good core strength, throwing technique and neuromuscular control are all signs an athlete has the physical maturity needed to do it well. Bender also recommends a simple screening exercise that helps identify if kids have the balance, core strength and stability required for such a complex motion.
“We ask kids to perform a single-leg squat, similar to a pistol squat,” says Bender. “If they don’t have the balance, if they wiggle all over or if they fall, they’re probably not ready for the challenge of standing and pushing off one leg while maintaining proper repeatable throwing mechanics.”
Once a pitcher begins to incorporate curveballs, prioritizing age-appropriate pitch counts, proper rest and recovery periods, and arm care routines can help minimize the risk of injury.
“Think big picture,” says Bender. “Parents, athletes, coaches and trainers should be proactive about monitoring workload more than anything.”
While there is no proof that throwing curveballs increases the risk of injury to throwing athletes, paying attention to an individual's specific needs and physical development is essential for protecting their overall health and performance.
These recommendations have been excerpted from Coaches Corner, a free monthly webinar series for coaches, athletic directors and athletic trainers. The series, developed and presented by Forté, in partnership with IHSAA, aims to arm coaching and support teams with helpful information to consider when working with their athletes. Subscribe online so you don’t miss an episode.
INDIANAPOLIS – Butler University's highly respected athletic program has new team members to assist in providing student-athletes with comprehensive medical care. Franciscan Health and Forté Sports Medicine and Orthopedics (formerly Methodist Sports Medicine) – long recognized as national leaders in orthopedic surgery and sports medicine – are joining their expertise and award-winning care processes to provide care for Butler University's athletic program.
Philip A. Blaney, MD, MBA, MS, medical director of Franciscan Physician Network Sports Medicine Specialists, has been appointed head team physician for Butler University. In that role, he will provide both primary care and sports medicine services to Butler's student-athletes. Dr. Blaney completed a sports medicine fellowship with Intermountain Healthcare-Utah Valley Orthopedic Center in Provo. Dr. Blaney was a head team physician for various high school teams and has served as a team physician for Purdue University. Currently, Dr. Blaney is also the head team physician for the Indianapolis Indians, the AAA affiliate of the Pittsburgh Pirates.
Franciscan Health will also provide full-time athletic trainers to augment the current Butler staff, allowing for enhanced coverage of practices and events.
"Butler University has a storied history in sports and continues to promote excellence both on the playing field and in academics," said James Callaghan, MD, president and CEO for Franciscan Health Central Indiana. "We're honored that Dr. Blaney will lead a team of clinicians who will provide stellar care to students."
Dr. Blaney will be joined on the sidelines by orthopedic surgeon Michael Bender, MD, of Forté Sports Medicine and Orthopedics. Dr. Bender is a fellowship-trained orthopedic surgeon specializing in shoulder and elbow disorders, with prior experience taking care of athletes as a team physician at Park Tudor and Indiana State University. Dr. Bender is a member of the prestigious American Shoulder & Elbow Surgeons (ASES) society. He performs all forms of minimally invasive and open shoulder and elbow procedures for patients of all ages.
Drs. Blaney and Bender will be supported by over 25 orthopedic surgeons from Forté Sports Medicine and Orthopedics who have sub-specialty training in foot/ankle, knee, hip, spine, hand/wrist, elbow shoulder and sports medicine. Franciscan Physician Network specialists will also support the team as needed, including providing comprehensive concussion care.
"With the addition of Franciscan Health and Forté's talented and dedicated physicians and staff, our student-athletes will receive high-level, comprehensive medical care," said Butler Vice President/Director of Athletics Barry Collier. "We are excited for this partnership that will add even more resources to Butler's sports medicine and sports performance staff under the direction of Ralph Reiff."
Butler University athletes will also have access to the new Franciscan Orthopedic Center of Excellence, to be located at 106th and Illinois streets in Carmel. Franciscan Health and Forté Sports Medicine and Orthopedics are partners in this venture which is set to open in early 2022. This facility will offer Butler athletes and active adults across Indiana and beyond, access to a highly focused orthopedic center of excellence for inpatient and outpatient surgery, specialty rehabilitation services and more.
