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I know there are joint replacements for fingers, knees, and hips. What about shoulders? I'm only 55, but I think I'm headed in that direction and thought I'd find out what's the current state-of-the-art, so-to-speak.

Shoulder replacements are available now and are usually reserved for older adults with severe osteoarthritis that is painful and limiting motion and function. Some time ago, artificial shoulder joint replacements were made available to younger patients with arthritis. But enough time has passed that we now know from short- to mid-range follow-up studies that this isn't always the perfect solution. The implant can wear out or loosen. Then it has to be replaced. That can mean a second surgery, loss of bone, further complications, and a major set back in motion and function. If only one side of the joint is affected, there's no need to replace the entire joint. Hemiarthroplasties are also used for some patients. The major downside of this approach is that the side that isn't replaced eventually wears out, too. Or the side with the replacement implant develops problems with loosening or biomechanical wear and tear. That means more surgery for those patients as well. What's the answer to this dilemma? The evidence supports delaying joint replacement by pursuing conservative (nonoperative) care for as long as possible. This may be of particular interest to you now since you are experiencing some problems. Patients have a few choices. Physical therapy to build up strength around the shoulder and minimize stress or overload on the joint is one approach. Acupuncture, transcutaneous nerve stimulation (TNS), and nonsteroidal antiinflammatories (NSAIDs) may be helpful. Like any medication, NSAIDs have the potential to create adverse reactions. The physician and the patient must weigh the benefits against the potential side effects when choosing these drugs. They may reduce painful inflammation and improve movement, but they can cause significant gastrointestinal (GI) complications and therefore, must be taken with another drug to protect the GI tract. Injections of a visco-supplement or steroid may provide some relief of pain compared with placebo (pretend injections of just saline, a salt solution). The visco-supplement is a fluid that helps restore pain free movement in the joint. It has been shown to be more effective and longer lasting than the steroid injections with fewer side effects. Steroid injections reduce inflammation and usually have a numbing agent included that helps reduce pain. Ask your doctor if you might be a candidate for either of these type of injections. When surgery is needed, it's best to start with noninvasive (or the least invasive) procedures possible. Every effort should be made to stimulate a healing response and save the joint, rather than remove and replace it. Joint sparing is the name given this approach. There are several ways to do this. The first (and most commonly used) procedure is called debridement. The joint is shaved and smoothed down. Any debris or loose fragments of cartilage are removed. This helps restore smooth, pain free motion. The benefits can last for several years or longer. You might benefit from one or more of these management techniques. Early conservative (nonoperative) care seems to have the best results. Don't wait any longer before seeking professional help from a sports specialist or orthopedic surgeon.

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