Shoulder replacement (arthroplasty) is a surgical procedure done when other treatments, such as medication or physical therapy, have not managed or helped with pain, or the shoulder cannot be used. A visit with an orthopedic surgeon will help you decide whether to have this surgery.

The conditions that lead to shoulder replacement surgery most often include:

• Osteoarthritis of the shoulder.
• Rotator cuff disease (a muscle tear or breakdown of the rotator cuff muscles).
• Shoulder fracture.

Less common reasons for surgery include:

• Rheumatoid arthritis.
• Osteonecrosis -- a rare condition in which the head of the arm bone dies.

There are three different types of shoulder arthroplasties. Your orthopedic surgeon will consider various factors. Your surgeon will decide whether or not one of these procedures is right for you:

Total shoulder arthroplasty. This surgery involves removing the ends of two bones at the shoulder and replacing them with artificial parts. The upper part of the arm bone is shaped like a ball. This is called the "head" of the shoulder. The head sits on a small socket in the shoulder blade to make the shoulder joint. During a TSA, the head is replaced by a ball-shaped metal implant. A small dish-like cup replaces the socket.

Shoulder hemiarthroplasty. This is a partial shoulder replacement. In this surgery, only the head of the arm bone is replaced with a metal ball.

Reverse total shoulder arthroplasty. In this procedure, the surgeon will reverse the ball and socket. Doctors recommend this surgery when there is damage to the rotator cuff muscles of the shoulder. The plastic device is attached to the top of the arm bone and the metal ball is attached to the socket. This allows the deltoid, another shoulder muscle, to provide movement. The deltoid compensates for the damaged rotator cuff muscles. This surgery can improve the range of motion, strength, and stability of your shoulder.

Physical therapy is vital for safe and healthy recovery after shoulder replacement surgery. After surgery, your physical therapist will guide you to improve your shoulder function and limit pain while you heal. As you regain strength and movement, your PT will help you safely return to your previous activity levels. The goal is to restore your ability to do household activities, job duties, and recreational hobbies.

Your PT also can work with you before surgery to help prepare your shoulder for surgery.

Shoulder replacement is typically an elective surgery. If you notice that your shoulder is painful and you lose the ability to use it, a physical therapist can help. A properly designed exercise program may help you delay or even avoid surgery. A physical therapist can teach you how to manage your pain and restore movement. Your unique treatment plan could focus on your posture, or on learning safe exercises for strength and flexibility. A stable and healthy shoulder joint requires regular activity and frequent exercises for strength. Your physical therapist will design an individual exercise program to address your specific needs and goals.

Proper nutrition and physical activity will keep all of your joints healthy! Avoid smoking or nicotine products. These are associated with inflammation and may limit your recovery from any injury.

All licensed physical therapists are prepared through education and experience to treat people before and after shoulder surgery. Consider finding a physical therapist who has experience treating individuals with musculoskeletal conditions. You may want to look for a specialized physical therapy clinic focused on orthopaedic conditions or sports medicine. You may choose to ask for a highly qualified physical therapist with postprofessional special training, such as one of these:

• A physical therapist who has completed a residency program and who has spent 1,500 hours to advance their knowledge and skills within a specific specialty area.
• A board-certified clinical specialist with advanced clinical knowledge, experience, and skills in geriatric, orthopaedic, or sports physical therapy.
• A physical therapist who has completed a fellowship program and has met specific criteria. These physical therapists have advanced knowledge and expertise in their specific area. You may want to look for a geriatrics, orthopaedic, or sports physical therapy fellow.

You can find a physical therapist who has these and other credentials by using Find a PT. This is an online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist or any other health care provider:

• Get recommendations from family, friends, or other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapist’s experience in helping people who have shoulder or orthopedic conditions.

Additional Resources

• Four Things to Expect After Shoulder Replacement Surgery
• Podcast: Total Shoulder Replacement