[Lani]

rina have you had steroids, both with your chemo and for your Sjogrens?

It can cause avascular necrosis of the humeral head, just like it can cause avascular necrosis of the hip. The hip is worse, as it is a weightbearing joint(unless you walk on your hands, in which case both would be equally bad!)

I recently saw an article that rituximab (an earlier monoclonal antibody than herceptin even,usually used for lymphoma) is effective vs Sjoegren's (sorry I don't have an umlaut key, or if I do, I don't know how to use it!)

I assume your bone on bone is the humeral head on the glenoid, not the A/C joint on itself ie the need for the total shoulder vs the trimming or resection of the joint Bill referred to (apples vs oranges)

Have antiinflammatories helped?

Have you had a diagnosic injection of your shoulder and related tendonshealths etc (different from a therapeutic injection?)

They use just local anaesthetic (can add the steroid later when then know which of the various areas are the cause of your pain) and place it one by one in each of the areas which might be the source of your pain and then ask you to move your shoulder and see if it hurts. Process of elimination.

It would be a shame to have your shoulder replaced if all your pain came from the biceps tendons sheath only or the A/C joint only (or a combination) or as a result of arthritic spurs and degenerative discs at the levels of your neck below your fusion (after one fuses parts of the neck, the other parts have to make up for it by moving more and they wear out faster!) Have you had your neck re-MRI's recently to see if any bone spurs or discs are pressing on the nerves exiting your neck going to the shoulder on the same side as your pain?

Sounds like it wouldn't hurt to try to do everything you can BEFORE agreeing to the total shoulder replacement to be AS CERTAIN AS YOU CAN BE that it really is the source of your pain and not something else that won't be helped by the surgery, as otherwise you may end up with perhaps less range of motion (they wouldn't promise you about that), perhaps some complication and perhaps still have your pain!

Are the surgeons you have been seeing specialized in shoulders only?

I sure ask a lot of questions, but I don't see how it can hurt if you ask a lot of questions, too. There is a theory that what wakes up the "sleeping" breast cancer stem cells is inflammation and the perceived need for the healing response including VEGF for angiogenesis. If that is true, it might imply that it might be wise to only do those surgeries necessary and do the smallest surgeries necessary to do the job (not a bad idea anyway). I wish Judah Folkmann were still alive. Until his premature death about a year and a half ago, he still operated as a pediatric surgeon and was a pioneering cancer researcher specializing in antiangiogenesis. Now he would be a man to ask!

Feel free to look up and watch the You-tube collection of his many wonderful lectures.

Hope this helps!