SHOULDER ARTHRITIS

SHOULDER ARTHRITIS

What is shoulder arthritis?

Osteoarthritis also known as “wear-and-tear” arthritis is a condition that erodes the smooth lining (articular cartilage) of a joint.  As the cartilage wears away, 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 (end of collar bone) joint than in the glenohumeral (ball and socket) shoulder joint.

There are other forms of arthritis that can affect the shoulder joint including rheumatoid arthritis. Rheumatoid arthritis is an inflammatory process that affects the lining of the joint causing swelling and pain.

Post-traumatic arthritis can occur after fractures of the upper arm bone or dislocation of the shoulder joint.

Rotator cuff tear arthritis occurs after large, longstanding rotator cuff tendon tears. The torn rotator cuff can no longer hold the ball of the joint firmly in the socket, causing it to rub up and down. This can damage the surfaces of the joint, causing arthritis to develop.

What are the symptoms of shoulder arthritis?

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

If the glenohumeral (ball & socket) shoulder joint is affected, the pain can be felt all around the shoulder spreading into the upper arm.  The pain is often worse and the shoulder more stiff to move first thing in the morning.

The pain of arthritis in the acromioclavicular (AC) joint is focused on the top of the shoulder at the end of the collarbone.  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 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 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.

How Is Shoulder Osteoarthritis Diagnosed?

To diagnose shoulder osteoarthritis, the doctor will take a medical history and do a physical exam to assess pain, tenderness, and loss of motion and to look for other signs in surrounding tissues. Certain tests like X-rays , CT Scan, MRI are advised to see the stage of arthritis.

What are the treatment options for shoulder arthritis?

As with other arthritic conditions, initial treatment of arthritis of the shoulder is nonsurgical.  This includes activity modification to avoid provoking pain.  Anti-inflammatory medication including oral painkillers and corticosteroid injection in the shoulder can reduce the inflammation and pain. Physiotherapy is also taught to patients to maintain muscle strength around the shoulder.

Surgical treatment is reserved for patients with failed nonsurgical treatments.

Is there a “keyhole” procedure to treat shoulder arthritis?

In cases of mild glenohumeral arthritis it could be treated with arthroscopy (“keyhole”) surgery.  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, the surgeon can debride (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.

Arthritis of the acromioclavicular joint is commonly treated by removing a small amount of bone from the end of your collarbone, leaving a space that gradually fills with scar tissue making a false joint.  This can be done to through a keyhole or an open technique.

In moderate to severe glenohumeral arthritis patients may need other surgical treatments such as a shoulder replacement.

  What is a shoulder replacement?

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 made from metal and plastic.

Replacement surgery options include:

Hemiarthroplasty. Just the ball of the joint is replaced by an artificial component.

Total shoulder arthroplasty. Both the ball and the socket are replaced. A plastic “cup” is fitted into the socket, and a metal “ball” is attached to the top of the arm.

Reverse total shoulder arthroplasty.  In a reverse total shoulder replacement, the socket and metal ball are the opposite way around compared to a conventional total shoulder arthroplasty.  The metal ball is fixed to the socket and the plastic cup is fixed to the upper end of the arm.  A reverse total shoulder replacement is designed for patients with torn rotator cuff tendons to allow them to use other muscles to raise their arm.

What is the recovery after shoulder replacement surgery?

Surgical treatment of arthritis of the shoulder is generally very effective in reducing pain and restoring motion.  Recovery time depends upon the type of surgery performed, but typically patients need to wear a sling for 4-6 weeks and it often takes at least three months to settle fully.

What are the complications of shoulder replacement surgery?

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.  Particularly with shoulder replacement surgery the artificial joint may wear and loosen over time, which may require further surgery in the future.