Shoulder Pain

Shoulder Arthritis

What is Shoulder Osteoarthritis?

Put simply, arthritis is inflammation of one or more of your joints. In the shoulder, inflammation causes pain and stiffness affecting both the glenohumeral and/or acromioclavicular joints. Although there is no cure for arthritis of the shoulder, there are many treatment options available. Most people with arthritis are able to manage pain and stay active.

Five major types of arthritis typically affect the shoulder.

Osteoarthritis

  • Osteoarthritis is a condition that affects the smooth outer covering (articular cartilage) of the bone.
  • As the cartilage wears, it becomes frayed and rough, and the protective space between the bones decreases.
  • During movement, the bones of the joint rub against each other, causing pain. 
  • Osteoarthritis usually affects people over 50 years of age and is more common in the acromioclavicular joint than in the glenohumeral shoulder joint.

shoulder arthritis 1

(Left) An illustration of damaged cartilage in the glenohumeral joint. (Right) This x-ray of the shoulder shows osteoarthritis and decreased joint space (arrow).

Rheumatoid Arthritis

  • Rheumatoid arthritis (RA) is a chronic disease that attacks multiple joints throughout the body.
  • It is symmetrical, meaning that it usually affects the same joint on both sides of the body.
  • The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move.
  • Rheumatoid arthritis causes the lining to swell, which causes pain and stiffness in the joint.
  • Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks one's own tissues. 

Post-traumatic Arthritis

  • Post-traumatic arthritis is a form of osteoarthritis that develops after an injury, such as a fracture or dislocation of the shoulder.

Rotator Cuff Tear Arthropathy

  • Arthritis can also develop after a large, long-standing rotator cuff tendon tear.
  • The torn rotator cuff can no longer hold the head of the arm bone (humerus) in the socket (glenoid) and the humerus can move upwards and rub against the acromion.
  • This can damage the surface of the bones, causing arthritis to develop.
  • The combination of a large rotator cuff tear and advanced arthritis can lead to severe pain and weakness, and the patient may not be able to lift the arm away from the side.

shoulder arthritis 2

Avascular Necrosis

  • Avascular necrosis (AVN) of the shoulder is a painful condition that occurs when the blood supply to the head of the humerus is disrupted.
  • Because bone cells die without a blood supply, AVN can ultimately lead to destruction of the shoulder joint and arthritis.
  • Avascular necrosis develops in stages. As it progresses, the dead bone gradually collapses, which damages the articular cartilage covering the bone and leads to arthritis.
  • At first, AVN affects only the head of the humerus, but as AVN progresses, the collapsed head of the humerus can damage the glenoid socket.
  • Causes of AVN include high dose steroid use, heavy alcohol consumption, sickle cell disease, and traumatic injury, such as fractures of the shoulder.
  • In some cases, no cause can be identified; this is referred to as idiopathic AVN.

What are the Symptoms of Shoulder Arthritis

Pain: The most common symptom of arthritis of the shoulder is pain, which is aggravated by activity and progressively worsens.

  • If the glenohumeral shoulder joint is affected, the pain is centered in the back of the shoulder and may intensify with changes in the weather. Patients complain of an ache deep in the joint.
  • The pain of arthritis in the acromioclavicular (AC) joint is focused on the top of the shoulder. This pain can sometimes radiate or travel to the side of the neck.
  • Someone with rheumatoid arthritis may have pain throughout the shoulder if both the glenohumeral and AC joints are affected.

Limited range of motion: Limited motion is another common symptom. It may become more difficult to lift your arm to comb your hair or reach up to a shelf. You may hear a grinding, clicking, or snapping sound (crepitus) as you move your shoulder.

As the disease progresses, any movement of the shoulder causes pain. Night pain is common and sleeping may be difficult.

What are the signs and symptoms of Shoulder Arthritis?

Medical History and Physical Examination

After discussing your symptoms and medical history, your clinician will examine your shoulder. During the physical examination, the specialist will look for:

  • Weakness (atrophy) in the muscles
  • Tenderness to touch
  • Extent of passive (assisted) and active (self-directed) range of motion
  • Any signs of injury to the muscles, tendons, and ligaments surrounding the joint
  • Signs of previous injuries
  • Involvement of other joints (an indication of rheumatoid arthritis)
  • Crepitus (a grating sensation inside the joint) with movement
  • Pain when pressure is placed on the joint

Do I need an investigations?

  • X-RaysX-rays are imaging tests that create detailed pictures of dense structures, like bone. They can help distinguish among various forms of arthritis. X-rays of an arthritic shoulder may show a narrowing of the joint space, changes in the bone, and the formation of bone spurs (osteophytes).

shoulder arthritis 3

This x-ray shows severe osteoarthritis of the glenohumeral joint.

What are the Treatments available for Shoulder Arthritis?

Non-surgical Treatment: As with other arthritic conditions, initial treatment of arthritis of the shoulder is nonsurgical.

  • Rest or change activities to avoid provoking pain. You may need to change the way you move your arm to do things.
  • Physical therapy exercises may improve the range of motion in your shoulder.
  • Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, may reduce inflammation and pain. These medications can irritate the stomach lining and cause internal bleeding. They should be taken with food. Consult with your doctor before taking over-the-counter NSAIDs if you have a history of ulcers or are taking blood thinning medication.
  • Corticosteroid injections in the shoulder can dramatically reduce the inflammation and pain. However, the effect is often temporary.
  • Moist heat
  • Ice your shoulder for a maximum of 15-20 minutes three or four times a day to reduce inflammation and ease pain. A bag of frozen peas wrapped in a tea towel is ideal (never put ice directly onto the skin)
  • If you have rheumatoid arthritis, your doctor may prescribe a disease-modifying drug, such as methotrexate.
  • Dietary supplements, such as glucosamine and chondroitin sulfate may help relieve pain. (Note: There is little scientific evidence to support the use of glucosamine and chondroitin sulfate to treat arthritis. Always consult your doctor before taking dietary supplements.)

Surgical Treatment: Your doctor may consider surgery if your pain causes disability and is not relieved with non-surgical options.

Arthroscopy:

  • Cases of mild glenohumeral arthritis may be treated with arthroscopy. During arthroscopy, the surgeon inserts a small camera, called an arthroscope, into the shoulder joint. The camera displays pictures on a television screen, and the surgeon uses these images to guide miniature surgical instruments.
  • Because the arthroscope and surgical instruments are thin, the surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.
  • During the procedure, your surgeon can clean out the inside of the joint. Although the procedure provides pain relief, it will not eliminate the arthritis from the joint. If the arthritis progresses, further surgery may be needed in the future.

Shoulder joint replacement (arthroplasty)

Advanced arthritis of the glenohumeral joint can be treated with shoulder replacement surgery, in which the damaged parts of the shoulder are removed and replaced with artificial components, called prosthesis.

shoulder arthritis 4

(Left) A conventional total shoulder replacement (arthroplasty) mimics the normal anatomy of the shoulder. (Right) In a reverse total shoulder replacement, the plastic cup inserts on the humerus, and the metal ball screws into the shoulder socket.

  • Hemiarthroplasty: Just the head of the humerus is replaced by an artificial component.
  • Total shoulder arthroplasty: Both the head of the humerus and the glenoid are replaced. A plastic "cup" is fitted into the glenoid, and a metal "ball" is attached to the top of the humerus.
  • Reverse total shoulder arthroplasty: In a reverse total shoulder replacement, the socket and metal ball are opposite a conventional total shoulder arthroplasty. The metal ball is fixed to the glenoid and the plastic cup is fixed to the upper end of the humerus. A reverse total shoulder replacement works better for people with cuff tear arthropathy because it relies on different muscles — not the rotator cuff — to move the arm.
  • Resection arthroplasty: The most common surgical procedure used to treat arthritis of the acromioclavicular joint is a resection arthroplasty. Your surgeon may choose to do this arthroscopically.In this procedure, a small amount of bone from the end of the collarbone is removed, leaving a space that gradually fills in with scar tissue.
  • Recovery: Surgical treatment of arthritis of the shoulder is generally very effective in reducing pain and restoring motion. Recovery time and rehabilitation plans depend upon the type of surgery performed.
  • Complications: As with all surgeries, there are some risks and possible complications. Potential problems after shoulder surgery include infection, excessive bleeding, blood clots, and damage to blood vessels or nerves.Your surgeon will discuss the possible complications with you before your operation.

What are the new treatments to look out for? 

Research is being conducted on shoulder arthritis and its treatment. 

  • In many cases, it is not known why some people develop arthritis and others do not. Research is being done to uncover some of the causes of arthritis of the shoulder.
  • Joint lubricants, which are currently being used for treatment of knee arthritis, are being studied in the shoulder.
  • New medications to treat rheumatoid arthritis are being investigated.
  • Much research is being done on shoulder joint replacement surgery, including the development of different joint prosthesis designs.
  • The use of biological materials to resurface an arthritic shoulder is also being studied. Biological materials are tissue grafts that promote the growth of new tissue in the body and foster healing.
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