Arthritis of the Shoulder
Arthritis, defined as inflammation of one or more joints, is a common ailment. According to the National Health Interview Survey, more than 52 million in the United States are diagnosed with some form of arthritis every year. When a patient has arthritis of the shoulder, he or she suffers from pain, stiffness, and often impaired range of motion due to the inflammation.
Anatomy of the Shoulder
The shoulder is made up of three bones: the humerus (the upper arm), the scapula (shoulder blade), and the clavicle (collarbone). The shoulder is a ball-and-socket joint. The head of the humerus (the ball) fits into the rounded socket of the shoulder blade (the glenoid). This is known as the glenohumeral joint. The other joint of the shoulder is the one in which the clavicle meets the tip of the should blade (acromion). This joint is called the acromioclarivular (AC) joint. The muscles and tendons that keep the arm bone centered in the shoulder socket are called the rotator cuff.
Types of Shoulder Arthritis
There are several types of shoulder arthritis. A qualified orthopedist like Dr. Peter D. McCann, who specializes in the shoulder and elbow, will be able to differentiate the various types and degrees of severity. The types of shoulder arthritis are:
- Osteoarthritis is caused by the wear and tear of bones rubbing against one another. This type of arthritis is typical of aging and is most common in the glenohumeral joint of people over 50.
- Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects many joints in the body. RA causes the synovium, the lining of the joints that lubricates them and eases movement, to swell, resulting in pain and stiffness.
- Post-traumatic arthritis occurs after a serious injury, such as a fracture or dislocation.
- Rotator cuff tear arthropathy occurs after a torn rotator cuff can’t hold the humerus head in the glenoid socket any longer.
- Avascular necrosis (AVN) is a condition resulting from interruption to the blood supply to the bone which causes tissue to die. AVN can be caused by steroid use, heavy alcohol use, sickle cell disease or traumatic injury. Sometimes no cause for the condition can be found.
Symptoms of Arthritis of the Shoulder
The most pervasive symptom of arthritis of the shoulder is pain which may worsen with changes in the weather. Arthritic pain is usually described as a deep ache in the joint and may become severe enough to interfere with sleep. Other symptoms of arthritis of the shoulder are:
- Limited range of motion
- Weakness (atrophy) of the muscles
- Tenderness to touch or pressure
- Signs of injury to muscles, tendons & ligaments around the joint
- Signs of previous injuries
- Crepitus, a grating sensation, accompanying movement of the joint
When pain is experienced in other joints as well as the shoulder, it may be an indication of rheumatoid arthritis.
Diagnosis of Arthritis of the Shoulder
In addition to a physical examination, X-rays will show detailed images of the joint structure that will assist Dr. McCann to diagnose the type and severity of arthritis. The X-rays provide visual evidence of narrowing joint space, changes in bone itself, and the presence of osteophytes (bone spurs).
Nonsurgical Treatment of Arthritis of the Shoulder
Arthritis of the shoulder is treated differently depending on its cause. In any case, it is recommended that the patient rest or change activities to prevent triggering the pain. Other nonsurgical treatments that may be helpful are:
- Physical therapy exercises to improve range of motion
- Injections of corticosteroids to help diminish pain and inflammation
- Nonsteroidal anti-inflammatory medications (NSAIDs) for pain relief
- Moist heat and/or ice alone of in alternating applications
- Special medications, such as methotrexate, for patients diagnosed with RA
There is some anecdotal evidence that dietary supplements, like glucosamine and chondroitin sulfate may help relieve pain, but there is little scientific research to support this.
Surgical Treatment for Arthritis of the Shoulder
Fortunately, in cases in which pain and dysfunction are unrelieved by nonsurgical methods, there are several surgical procedures that can repair the damage and restore function to the arthritic joint. These include:
Arthroscopy — Cases of mild arthritis may be treated arthroscopically. During arthroscopic surgery, the surgeon makes only small incisions. A tiny camera is inserted into the shoulder providing enlarged images on a computer screen. These images (in real time) assist the surgeon in guiding miniature surgical instruments with great precision as the procedure is performed. This type of surgery causes less pain, leaves less scarring and results in a speedier recovery for the patient than open surgery. During arthroscopy, the surgeon can also debride, or clean out, any debris inside the joint.
Arthroplasty (Shoulder Joint 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, called a prosthesis. There are several types of shoulder replacement surgery, including: hemiarthroplasty, total shoulder arthroplasty, reverse total shoulder arthroplasty, and resection arthroplasty.
Currently, extensive research is being done on shoulder surgery as a treatment for arthritis. As joint prostheses are refined and new biologic materials are developed, shoulder replacement surgery is becoming more efficient and healing times are improving.