When a person has scoliosis, their backbone curves to the side.

The angle of the curve may be small, large or somewhere in between. But anything that measures more than 10 degrees is considered scoliosis. Doctors may use the letters “C” and “S” to describe the curve of the backbone.

You probably don’t look directly at too many spines, but what you might notice about someone with scoliosis is the way they stand. They may lean a little or have shoulders or hips that look uneven.

In as many as 80% of cases, doctors don’t find the exact reason for a curved spine. Scoliosis without a known cause is what doctors call “idiopathic.”

Some kinds of scoliosis do have clear causes. Doctors divide those curves into two types — structural and nonstructural.

In nonstructural scoliosis, the spine works normally, but looks curved. Why does this happen? There are a number of reasons, such as one leg’s being longer than the other, muscle spasms, and inflammations like appendicitis. When these problems are treated, this type of scoliosis often goes away.

In structural scoliosis, the curve of the spine is rigid and can’t be reversed.

Causes include:

• Cerebral palsy
• Muscular dystrophy
• Birth defects
• Infections
• Tumors
• Genetic conditions like Marfan syndrome and Down syndrome

Congenital scoliosis begins as a baby’s back develops before birth. Problems with the tiny bones in the back, called vertebrae, can cause the spine to curve. The vertebrae may be incomplete or fail to divide properly. Doctors may detect this condition when the child is born. Or, they may not find it until the teen years.

Family history and genetics can also be risk factors for idiopathic scoliosis. If you or one of your children has this condition, make sure your other kids are screened regularly.

Scoliosis shows up most often during growth spurts, usually when kids are between 10 and 15 years old. About the same number of boys and girls are diagnosed with minor idiopathic scoliosis. But curves in girls are 10 times more likely to get worse and may need to be treated.

Scoliosis diagnosed during the teen years can continue into adulthood. The greater the angle of the spine curve, the more likely it is to increase over time. If you had scoliosis in the past, have your doctor check your back regularly.

Degenerative scoliosis affects adults. It usually develops in the lower back as the disks and joints of the spine begin to wear out as you age.

Treatments:

The main type of surgery for scoliosis involves attaching rods to the spine and doing a spinal fusion. Spinal fusion is used to stabilize and reduce the size of the curve and stop the curve from getting worse by permanently joining the vertebrae into a solid mass of bone.

Other techniques are sometimes used, including instrumentation without fusion, which attaches devices such as metal rods to the spine to stabilize a spinal curve without fusing the spine together. This is only done in very young children when a fusion, which stops the growth of the fused part of the spine, is not desirable. The child usually has to wear a brace full-time after having this surgery.

Neck strain is often just called whiplash. Although it’s usually associated with car accidents, any impact or blow that causes your head to jerk forward or backward can cause neck strain. The sudden force stretches and tears the muscles and tendons in your neck.

Neck strain afflicts many amateur and professional athletes. People who play contact sports like football are especially prone to neck strain.

Neck strains are often confused with neck sprains. They’re a bit different. Neck strains are caused by damage to the muscle or the tendons, bands of tissue that connect muscles to bones. Neck sprains are caused by tearing of the ligaments, the tissues that connect the bones to each other.

However, the differences between these strains and sprains probably won’t mean much to you. The causes, symptoms, and treatment of neck sprains and neck strains are usually the same.

The pain of whiplash is often hard to ignore. The symptoms may include:

• Pain, decreased range of motion, and tightness in the neck. The muscles may feel hard or knotted.
• Pain when rocking your head from side to side or backward and forward.
• Pain or stiffness when moving your head to look over each shoulder.
• Tenderness.
• Headaches at the base of the skull that radiate towards the forehead.

Sometimes, the pain of a neck strain is immediate. In other cases, it can take several hours or days before your neck begins to hurt.

The blow that causes neck strain can sometimes cause a concussion, too. Since concussions can be serious, you need to see a doctor right away. You need emergency medical care if you have a headache that worsens or persists, have weakness or trouble talking, or are confused, dizzy, nauseous, excessively sleepy, or unconscious.

To diagnose neck strain, your doctor will give you a thorough examination. You may also need X-rays, CT (computed tomography) scans, and other tests, to rule out other problems.

Here’s the good news: given time, whiplash should heal on its own. To help with recovery, you should:

• Ice your neck to reduce pain and swelling as soon as you can after the injury. Do it for 15 minutes every 3-4 hours for 2-3 days. Wrap the ice in a thin towel or cloth to prevent injury to the skin.
• Take painkillers or other drugs, if recommended by your doctor. Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil, Motrin) or naproxen (Aleve), will help with pain and swelling. However, these medicines can have side effects. Never use them regularly unless your doctor specifically says you should. Check with your doctor before taking them if you take other medicines or have any medical problems. If over the counter medications do not work, prescription painkillers and muscle relaxants may be necessary.
• Use a neck brace or collar to add support, if your doctor recommends it. However, they are not recommended for long-term use, because they can actually weaken the muscles in your neck.
• Apply moist heat to your neck — but only after 2-3 days of icing it first. Use heat on your neck only after the initial swelling has gone down. You could use warm, wet towels or take a warm bath.
• Other treatments, like ultrasound and massage, may also help.

A bulging disc can have a number of different causes, including trauma from a sports-related injury or a car accident. The condition’s most common cause, however, is the natural aging process. Over time, parts of the spine begin to break down after age-related changes make them less able to support body weight and allow the spine to bend and twist. The spinal discs, which are located between adjacent vertebrae and act as shock absorbers, are prone to shrinkage and water loss as you grow older. This can lead to a loss of elasticity, which can cause the outer layer of a disc to bulge out from between the surrounding vertebrae.

Valley fever is a fungal infection caused by coccidioides organisms. It can cause fever, chest pain and coughing, among other signs and symptoms.

Two species of coccidioides fungi cause valley fever. These fungi are commonly found in soil in specific regions. The fungi’s spores can be stirred into the air by anything that disrupts the soil, such as farming, construction and wind.

The fungi can then be breathed into the lungs and cause valley fever, also known as acute coccidioidomycosis. Mild cases of valley fever usually resolve on their own. In more severe cases, doctors prescribe antifungal medications that can treat the underlying infection.

Symptoms

Valley fever is the initial form of coccidioidomycosis infection. This initial, acute illness can develop into a more serious disease, including chronic and disseminated coccidioidomycosis.

Acute coccidioidomycosis (valley fever)

The initial, or acute, form of coccidioidomycosis is often mild, with few, if any, symptoms. When signs and symptoms do occur, they appear one to three weeks after exposure. They tend to resemble those of the flu, and can range from minor to severe, including:

• Fever
• Cough
• Chest pain
• Chills
• Night sweats
• Headache
• Fatigue
• Joint aches
• Red, spotty rash

The rash that sometimes accompanies valley fever is made up of painful red bumps that may later turn brown. The rash mainly appears on your lower legs, but sometimes on your chest, arms and back. Others may have a raised red rash with blisters or eruptions that look like pimples.

If you don’t become ill from valley fever, you may only find out you’ve been infected when you later have a positive skin or blood test or when small areas of residual infection (nodules) in the lungs show up on a routine chest X-ray. Although the nodules typically don’t cause problems, they can look like cancer on X-rays.

If you do develop symptoms, especially severe ones, the course of the disease is highly variable. It can take months to fully recover, and fatigue and joint aches can last even longer. The severity of the disease depends on several factors, including your overall health and the number of fungus spores you inhale.

Chronic coccidioidomycosis

If the initial coccidioidomycosis infection doesn’t completely resolve, it may progress to a chronic form of pneumonia. This complication is most common in people with weakened immune systems.

Signs and symptoms include:

• Low-grade fever
• Weight loss
• Cough
• Chest pain
• Blood-tinged sputum (matter discharged during coughing)
• Nodules in the lungs

Disseminated coccidioidomycosis

The most serious form of the disease, disseminated coccidioidomycosis, occurs when the infection spreads (disseminates) beyond the lungs to other parts of the body. Most often these parts include the skin, bones, liver, brain, heart, and the membranes that protect the brain and spinal cord (meninges).

The signs and symptoms of disseminated disease depend on which parts of your body are affected and may include:

• Nodules, ulcers and skin lesions that are more serious than the rash that sometimes occurs with other forms of the disease
• Painful lesions in the skull, spine or other bones
• Painful, swollen joints, especially in the knees or ankles
• Meningitis — an infection of the membranes and fluid surrounding the brain and spinal cord

When to see a doctor

Seek medical care if you are over 60, have a weakened immune system, are pregnant, you develop the signs and symptoms of valley fever, especially if you:

• Live in or have recently traveled to an area where this disease is common
• Have symptoms that aren’t improving

Be sure to tell your doctor if you’ve traveled to a place where valley fever is endemic and you have symptoms.

Treatment

Rest

Most people with acute valley fever don’t require treatment. Even when symptoms are severe, the best therapy for otherwise healthy adults is often bed rest and fluids — the same approach used for colds and the flu. Still, doctors carefully monitor people with valley fever.

Antifungal medications

If symptoms don’t improve or become worse or if you are at increased risk of complications, your doctor may prescribe an antifungal medication, such as fluconazole. Antifungal medications are also used for people with chronic or disseminated disease.

In general, the antifungal drugs fluconazole (Diflucan) or itraconazole (Sporanox, Onmel) are used for all but the most serious forms of coccidioidomycosis disease.

All antifungals can have serious side effects. However, these side effects usually go away once the medication is stopped. Possible side effects of fluconazole and itraconazole are nausea, vomiting, abdominal pain and diarrhea.

More serious infection may be treated initially with an intravenous antifungal medication such as amphotericin B (Abelcet, Amphotec, others).

Two newer medications — voriconazole and posaconazole (Noxafil) — may also be used to treat more serious infections.

Antifungals control the fungus, but sometimes don’t destroy it, and relapses may occur. For many people, a single bout of valley fever results in lifelong immunity, but the disease can be reactivated, or you can be reinfected if your immune system is significantly weakened.

Prevention

If you live in or visit areas where valley fever is common, take commonsense precautions, especially during the summer months when the chance of infection is highest. Consider wearing a mask, staying inside during dust storms, wetting the soil before digging, and keeping doors and windows tightly closed

Dermatomycosis is a fungal skin disease. This ailment, also known as trichophytosis, causes fungal bacteria Microsporum or Trichophyton. A person can get infected both from another person, and from an animal. It is important to conduct timely treatment of the disease in order to prevent the development of complications.

Usually pathology develops on:

• smooth skin;
• head in the area of ​​hair growth
• external genitals
• skin of the feet.

The majority of patients with trichophytosis are children, and inguinal dermatomycosis is a disease most often affected by adults. It is characterized by the appearance of erythematous-type plaques and severe itching.

Ways of infection

Dermatomycosis can be purchased if:

1.  contacting the patient
2.  touch objects that the patient uses;
3.  contact with stray animals
4.  touch the seat backs in public transport

Trichophytosis of smooth skin is a more rare phenomenon and occurs with close contact with the diseased. The chronic appearance of the disease develops in patients with weakened immunity, and also usually manifests itself in childhood. He does not heal to the end, but proceeds in a latent form. Such patients have flaky areas on the skin, which are usually localized in the region of the temples or occiput.

Classification of ailment

Dermatomycosis can be of the following types:

• Mycosis on the feet
• smooth skin dermatomycosis. It is shown by peeling spots from white to brown, which are usually localized on the shoulders, back or neck. They can grow over time;
• dermatomycosis of feet and hands. Dermatomycosis of the foot is characterized by the appearance of spots and itchy cracks on the legs. This type of disease is characterized by the appearance of sores and blisters
• inguinal dermatomycosis. The spots are localized on the lower part of the abdomen, hips (especially on the inner surface), buttocks or perineum. Inguinal dermatomycosis involves the presence of spots that have inflammatory areas and are colored in different shades — from pink to brown
• Mycosis of the scalp. It usually occurs in children and is manifested by the presence of round spots, which are shelled. At the site of their localization the patient’s hair falls out or thinens. When breaking the hair in its place, there remains a stump, which looks like a black dot;
• onychomycosis. Affects nails. They change their color and become thicker. Affected nails often crumble;
• face dermatomycosis. It affects the upper or lower lip, as well as the skin on the chin. Characterized by the appearance of nodes that have a bluish tint, which contain a turbid liquid. After the merging of such nodes, the skin becomes rough.

Symptoms:

Symptoms of trichophytosis usually begin to appear one week after contact with a sick person, animal or objects that the infected person used. Symptoms vary depending on the site of the skin lesion

1.  The superficial lesion is characteristic of the head and smooth skin. In this case, the skin forms circular plaques, which can easily be seen with the naked eye. If the plaque is formed on the site of the hair follicle, then the hair in this place begins to break down or falls out. On the remaining hair there is a plaque of gray color, which is a fungal spore (a characteristic symptom). Smooth plaques are formed on the smooth skin, which itch, and have a rim painted in red;
2.  inguinal skin lesions are characterized by the appearance of symptoms of inflammation in the groin, buttocks or thighs. It arises because of neglect of the rules of personal hygiene, the wearing of linen from synthetic materials, as well as high sweating
3.  Onychomycosis promotes the appearance of white or yellow spots on the nail plate.

If you do not notice the symptoms of dermatomycosis of the feet or other part of the body in time, it leads to complications of an infectious nature. On the affected areas, pus can form, which will contribute to worsening of well-being. There are headaches, general weakness and enlarged lymph nodes.

Treatments:

Treatment of pathology involves antifungal therapy. If therapy is started at the first symptoms of the disease, it will be highly effective and will help to completely cure the patient of dermatomycosis. The doctor prescribes ointments, creams or shampoos that contain antifungal agents to treat the patient. These include Exoderyl, Lamisil and other means. Another method of treatment is rubbing the affected areas with iodine.

To get rid of inflammation, the patient should take anti-inflammatory and hormonal drugs.

When the first signs of skin damage appear, the patient should immediately consult a doctor so that he is given the right treatment, because self-medication can lead to various complications that worsen the appearance of the skin and the general condition of a person. During the prescribed course of treatment, the patient should be isolated from contact with others.

Treatment with folk remedies is also effective. There are such popular recipes:

• grease the cabbage leaf with sour cream and apply to the affected skin
• mix mustard with vinegar and make a medical compress

Tonsillitis is inflammation of the tonsils caused by bacterial or viral infection. Typical symptoms are sore throat, swollen tonsils, difficulty swallowing, fever, and swollen glands in the neck.Treatment will differ depending on whether the cause is bacterial or viral.

Causes and Symptoms of Tonsillitis

Bacterial and viral infections can cause tonsillitis. A common cause is Streptococcus (strep) bacteria. Other common causes include:

• Adenoviruses
• Influenza virus
• Epstein-Barr virus
• Parainfluenza viruses
• Enteroviruses
• Herpes simplex virus

The main symptoms of tonsillitis are inflammation and swelling of the tonsils, sometimes severe enough to block the airways. Other symptoms include:

• Throat pain or tenderness
• Redness of the tonsils
• A white or yellow coating on the tonsils
• Painful blisters or ulcers on the throat
• Headache
• Loss of appetite
• Ear pain
• Difficulty swallowing or breathing through the mouth
• Swollen glands in the neck or jaw area
• Fever, chills
• Bad breath

In children, symptoms may also include:

• Nausea
• Vomiting
• Abdominal pain

Treatment for tonsillitis will depend in part on the cause. To determine the cause, your doctor may perform a rapid strep test or throat swab culture. Both tests involve gently swabbing the back of the throat close to the tonsils with a cotton swab. A lab test can detect a bacterial infection. A viral infection will not show on the test, but may be assumed if the test for bacteria is negative. In some cases, the physical findings are convincing enough to diagnose a probable bacterial infection. In these cases, antibiotics may be prescribed without performing a rapid strep test

If tests reveal bacteria, treatment will consist of antibiotics to cure the infection. Antibiotics may be given as a single shot or taken 10 days by mouth. Although symptoms will likely improve within two or three days after starting the antibiotic, it’s important to take all of the medication your doctor prescribes to make sure the bacteria are gone. Some people need to take a second course of antibiotics to cure the infection.

What causes bone loss?

Bone loss is a common consequence of loss of teeth and chronic periodontitis. In the case of periodontitis, the bacteria gradually eats away at the underlying jawbone and at the periodontal ligaments that connect the tooth to the bone.

The most common cause of bone loss is tooth loss left unreplaced, especially multiple teeth. Jawbone is preserved through the pressure and stimulus of chewing. When that is removed through tooth loss, the bone “resorbs” (reabsorbs) into the body. In the first year after tooth extraction 25% of bone is lost, and this bone loss continues on.

Bone loss

This bone loss occurs in the bone surrounding and supporting the tooth, known as alveolar bone. Alveolar bone forms the ridges in which the teeth are embedded. These ridges atrophy both vertically and horizontally.

Replacing teeth with full or partial dentures doesn’t solve the problem as the dentures exert a very small amount of chewing pressure on the bone compared to natural teeth, as low as 10% or less.

Removal of the molars in the upper jaw can cause additional resorption of the bone due to expansion of the sinus cavity. With no teeth in place, the air pressure in the sinus cavity can cause resorption of the bone lining the sinuses.

Other causes of bone loss

• Bone loss can also be caused by misaligned teeth, creating a situation where normal chewing doesn’t occur, causing loss of the needed stimulus to the bone.
• Bone can be lost through infection that damages the bone.
• A large tumor in the face may require removal of the tumor and some of the jaw.

Bone loss and dentures

Dentures can accelerate bone loss by wearing away at the ridges of bone they are placed on. Every time you bite down or clench your teeth you are placing pressure on the ridge, resulting in its resorption. This is a primary cause of continual problems on getting dentures to fit, of sore spots and difficult or painful chewing.

People who wear dentures can experience another severe consequence of bone loss: collapse of the lower third of their face.

Bone loss and dentures

Dentures can accelerate bone loss by wearing away at the ridges of bone they are placed on. Every time you bite down or clench your teeth you are placing pressure on the ridge, resulting in its resorption. This is a primary cause of continual problems on getting dentures to fit, of sore spots and difficult or painful chewing.

People who wear dentures can experience another severe consequence of bone loss: collapse of the lower third of their face.

The loss of the ridge bone brings your chin closer to the nose, causing your jaw to jut out and your nose appears to stick out further because your upper lip has puckered in. Deep wrinkles appear around the mouth and the cheeks develop “jowls”— sagging skin. This facial collapse can appear to age you by many years!

Preventing bone loss

Bone loss can be prevented by giving the jawbone a replacement tooth with a root that can exert the same or similar pressure as natural teeth. This is done immediately after extraction by replacing single teeth with dental implants, or by using a fixed implant-supported bridge or denture.

A single-tooth implant or a dental bridge with three to four teeth supported by two implants provide a chewing power of 99% of natural bite force. A denture secured with dental implants, such as our Same Day Teeth procedure, provides about 70% to 80% of normal biting force and helps considerably in preventing bone loss.

What about loss of bone density?

When bones loses density it becomes more porous. Density loss is much less common than loss of bone volume, but is something we need to watch out for. Bone can lose density because of a variety of factors, including diet, hormonal imbalance, disease, lifestyle, and even tooth loss.

We can detect low density bone ahead of time using our 3D cone beam CT scanner to capture 3D images. The whiter the color of the bone in the X-ray, the denser it is. We can then avoid these areas of low density, or take precautions by using special implants with a surface that draws the bone to it, which creates denser bone around the implant.

Bone Grafting:

We also use bone grafting to repair damaged and lost bone around teeth that have suffered from severe gum disease.In cases where bone has already been lost, bone grafting might be needed to provide enough bone for dental implant placement. We need enough height of the ridge for any teeth replacement with implants, and when replacing the back teeth (molars), we also need enough width.

A bone graft not only replaces lost bone, it also stimulates the jawbone to regrow and eventually replaces the bone graft with the patient’s own, healthy bone. We use a variety of different types of bone graft material, depending on the patient, including new cutting-edge materials that require less healing time.

Minimally invasive dental implants

The implant unless the bone loss is severe, in which case it might need to be done as a separate procedure. They use minimally invasive methods, including a gentle laser.

Sinus Lifts

When your upper back teeth have been removed, the ridge bone resorbs and the sinus cavity expands, so that eventually the bone separating the sinus cavity and the oral cavity is very thin.

Dental implants can’t be placed in such thin bone and in these cases. The sinus is raised by gently pushing up the membrane lining the sinus away from your jaw and packing in bone graft material into the space where the sinus cavity was. Once the bone graft material has fully integrated with the jawbone, we can lace your implants.

When bone loss doesn’t need bone grafting or sinus lifts:

The good news is that we can help many patients get implants without any kind of bone grafting through the use of our 3D cone beam CT scanner. This breakthrough technology allows us to see the teeth, jaw and related structures in full 360º view. We can measure the exact width and height of your ridges and assess how much, if any, bone grafting is actually needed. In many cases we can find enough bone to use for implants.

The 3D scanner also permits us to perform procedures such as full-mouth teeth replacement, which can be done using just four implants per arch placed where we can take advantage of the bone available.

What is an ectopic pregnancy?

In a normal pregnancy, a fertilized egg travels through a fallopian tube to the uterus. The egg attaches in the uterus and starts to grow. But in an ectopic pregnancy , the fertilized egg attaches (or implants) someplace other than the uterus, most often in the fallopian tube. (This is why it is sometimes called a tubal pregnancy.) In rare cases, the egg implants in an ovary, the cervix, or the belly.

There is no way to save an ectopic pregnancy. It cannot turn into a normal pregnancy. If the egg keeps growing in the fallopian tube, it can damage or burst the tube and cause heavy bleeding that could be deadly. If you have an ectopic pregnancy, you will need quick treatment to end it before it causes dangerous problems.

An ectopic pregnancy is often caused by damage to the fallopian tubes. A fertilized egg may have trouble passing through a damaged tube, causing the egg to implant and grow in the tube.

Things that make you more likely to have fallopian tube damage and an ectopic pregnancy include:

• Smoking. The more you smoke, the higher your risk of an ectopic pregnancy.
• Pelvic inflammatory disease (PID). This is often the result of an infection such as chlamydia or gonorrhea.
• Endometriosis, which can cause scar tissue in or around the fallopian tubes.
• Being exposed to the chemical DES before you were born.

Some medical treatments can increase your risk of ectopic pregnancy. These include:

• Surgery on the fallopian tubes or in the pelvic area.
• Fertility treatments such as in vitro fertilization.

In the first few weeks, an ectopic pregnancy usually causes the same symptoms as a normal pregnancy, such as a missed menstrual period, fatigue, nausea, and sore breasts.

The key signs of an ectopic pregnancy are:

• Pelvic or belly pain. It may be sharp on one side at first and then spread through your belly. It may be worse when you move or strain.
• Vaginal bleeding.

If you think you are pregnant and you have these symptoms, see your doctor right away.

The most common treatments are medicine and surgery. In most cases, a doctor will treat an ectopic pregnancy right away to prevent harm to the woman.

Medicine can be used if the pregnancy is found early, before the tube is damaged. In most cases, one or more shots of a medicine called methotrexate will end the pregnancy. Taking the shot lets you avoid surgery, but it can cause side effects. You will need to see your doctor for follow-up blood tests to make sure the shot worked.

For a pregnancy that has gone beyond the first few weeks, surgery is safer and more likely to work than medicine. If possible, the surgery will be laparoscopy . This type of surgery is done through one or more small cuts (incisions) in your belly. If you need emergency surgery, you may have a larger incision.

Joint replacement involves surgery to replace the ends of bones in a damaged joint. This surgery creates new joint surfaces.

In shoulder replacement surgery, doctors replace the ends of the damaged upper arm bone (humerus) and usually the shoulder bone (scapula) or cap them with artificial surfaces lined with plastic or metal and plastic. Shoulder joint components may be held in place with cement. Or they may be made with material that allows new bone to grow into the joint component over time to hold it in place without cement.

The top end of your upper arm bone is shaped like a ball. Muscles and ligaments hold this ball against a cup-shaped part of the shoulder bone. Surgeons usually replace the top of the upper arm bone with a long metal piece, inserted into your upper arm bone, that has a rounded head. If the cup-shaped surface of your shoulder bone that cradles your upper arm bone is also damaged, doctors smooth it and then cap it with a plastic or metal and plastic piece.

Surgeons are now trying a newer procedure called a reverse total shoulder replacement for people who have painful arthritis in their shoulder and also have damage to the muscles around the shoulder. In this procedure, after the surgeon removes the damaged bone and smooths the ends, he or she attaches the rounded joint piece to the shoulder bone and uses the cup-shaped piece to replace the top of the upper arm bone. Early results are encouraging. This surgery is not right for everyone. And not all surgeons have done it. Success depends not only on careful evaluation to be sure it’s the right surgery for you but also on having a surgeon with experience in reverse shoulder replacement.

Doctors often use general anesthesia for joint replacement surgeries. This means you’ll be unconscious during surgery. But sometimes they use regional anesthesia, which means you can’t feel the area of the surgery and you are sleepy, but you are awake. The choice of anesthesia depends on your doctor, on your overall health, and, to some degree, on what you prefer.

Your doctor may recommend that you take antibiotics before and after the surgery to reduce the risk of infection. If you need any major dental work, your doctor may recommend that you have it done before the surgery. Infections can spread from other parts of the body, such as the mouth, to the artificial joint and cause a serious problem.

You will have intravenous (IV) antibiotics for about a day after surgery. You will also receive medicines to control pain and perhaps medicines to prevent blood clots. It is not unusual to have an upset stomach or feel constipated after surgery. Talk with your doctor or nurse if you don’t feel well.

When you wake up from surgery, you will have a bandage on your shoulder and probably a drain to collect fluid and keep it from building up around your joint. You may have a catheter, which is a small tube connected to your bladder, so you don’t have to get out of bed to urinate. You may also have a compression sleeve on your arm. This sleeve squeezes your arm to keep the blood circulating and to help prevent blood clots.

A physical therapist may begin gentle exercises of your shoulder on the day of surgery or the day after. These exercises are just passive motion, which means you relax and let the therapist move your arm for you.

Most people who have shoulder replacement surgery are able to sit up and get out of bed with some help later on the day of surgery.

Your doctor may teach you to do simple breathing exercises to help prevent congestion in your lungs while your activity level is reduced.

The first few days

You will probably still be taking some medicine. You will gradually take less and less pain medicine. You may continue taking medicines to prevent blood clots for several weeks after surgery.

A physical therapist will move your arm for you to keep your shoulder loose as it heals. The therapist will also show you how to use a pulley device so you can move your arm when you go home from the hospital. Your therapist may also begin some simple exercises to keep the muscles of your other arm and your legs strong.

Rehabilitation (rehab) after a shoulder replacement starts right away. It is not too demanding early on, but it is very important that you do it. Most doctors will not allow you to use the shoulder muscles for several weeks after surgery. The main goal of rehab is to allow you to move your shoulder as far as possible so it’s easier for you to do daily activities, such as dressing, cooking, and driving. Most people eventually regain about two-thirds of normal shoulder motion after surgery. But other things that affect how much movement you get back after surgery are how much movement you had before surgery and whether the soft tissues around your shoulder were also damaged. It is very important that you take part in physical therapyboth while you are in the hospital and after you are released from the hospital to get the most benefit from your surgery.

Most people go home 1 to 3 days after surgery. Some people who need more extensive rehab or those who don’t have someone who can help at home go to a specialized rehab center for more treatment.

The risks of shoulder replacement surgery include:

• Blood clots. People can develop a blood clot in a leg vein after shoulder joint replacement surgery but usually only if they are inactive. Bloodclots can be dangerous if they block blood flow from the leg back to the heart or move to the lungs. Blood clots occur more commonly in older people, people who are very overweight, people who have had blood clots before, and those who have cancer.
• Infection in the surgical wound or in the joint. Infection is rare in people who are otherwise healthy. People who have other health problems, such as diabetes, rheumatoid arthritis, or chronic liverdisease, or those who are taking corticosteroids are at higher risk of infection after any surgery. Infections in the wound usually are treated with antibiotics. Infections deep in the joint may require more surgery. And in some cases the artificial joint must be removed.
• Nerve injury. In rare cases, a nerve may be injured around the site of the surgery. It is more common (but still unusual) if the surgeon is also correcting deformities in the joint. A nerve injury may cause tingling, numbness, or difficulty moving a muscle. These injuries usually get better over time and in some cases may go away completely.
• Problems with wound healing. Wound healing problems are more common in people who take corticosteroids or who have diseases that affect the immune system, such as rheumatoid arthritis and diabetes.
• Lack of good range of motion. How far you can move your shoulder after surgery depends a lot on how far you could move your shoulder before surgery. Some people are not able to move their shoulder far enough to allow them to do their regular daily activities, even after several weeks of recovery. If this happens, the doctor may give you a medicine to relax your muscles and will gently force the shoulder to move farther. This may loosen tissues around the joint that are preventing you from bending it.
• Dislocation of the upper arm bone (humerus). This usually only happens if the soft tissues around the shoulder are stretched too soon after surgery. To help prevent dislocation, do not allow your elbow to move past your body toward your back.
• Fracture of the upper arm bone. This is an unusual complication, but it may happen either during or after surgery.
• Instability in the joint. This can be the result of either the soft tissues being stretched too soon after surgery, or the new joint pieces loosening.
• The usual risks of general anesthesiarisks of general anesthesia. Risks of any surgery are higher in people who have had a recent heart attackand those who have long-term (chronic) lung, liver, kidney, or heart disease.