A narrative review of non-infected painful total shoulder arthroplasty: evaluation and treatment.

Background and Objective: 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. Methods: A database search of PubMed and Google Scholar was conducted including studies relating to painful shoulder arthroplasty evaluation, management, and treatment. Key Content and Findings: 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. Conclusions: 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.