Inclusion Criteria:  Patients between the age of 55 and 80 who are indicated for a TSA, including both anatomic (maintaining anatomic location of the ball and socket in the shoulder) and reverse (reverses where the ball and socked are placed) total shoulder arthroplasties.  Exclusion Criteria:  Patients undergoing:  revision total shoulder arthroplasty TSA for a fracture Patients with a history of narcotic abuse. Patients unwilling or unable to receive and interscalene block Patients with Raynaud's disease, vasospastic disease, or other circulatory dysfunction Patients with cold hypersensitivity, decreased skin sensitivity related to temperature Patients with central ports, PICC lines, or other indwelling IV access on the affected side.