March 6, 2017

How to treat shoulder arthritis

Shoulder

Shoulder arthritis is also referred to as glenohumeral arthritis. Arthritis is a loss of articular cartilage (the surface on the ends of your bones in joints). Osteoarthritis (wear and tear arthritis) is most common but inflammatory conditions such as rheumatoid arthritis also can lead to loss of articular cartilage.

Anatomy

The shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle). The shoulder is a ball-and-socket joint, which means the ball of the upper arm fits into a shallow socket in your shoulder blade.

The ball stays in the shoulder socket with the help of static restraints (labrum and ligaments) and dynamic restraints (the rotator cuff and scapular muscles). The rotator cuff is made up of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.

The glenoid is the socket that the humerus fits in. This socket is surrounded by a fibrocartilaginous structure called the labrum that helps the head of the upper arm fit into the shoulder socket.

Where the head of the humerus fits into the scapula is called the glenohumeral joint.

Cause

Five major types of arthritis in the shoulder.

  • Osteoarthritis: Also called “wear-and-tear” arthritis, this condition destroys the smooth outer covering of bone. As the cartilage wears away it becomes frayed and rough, which results in the protective space between the bones decreasing. The bones of the joint rub against each other causing pain.
  • Rheumatoid Arthritis (RA): RA is a chronic disease that attacks multiple joints throughout the body. It is symmetrical and usually affects the same joint on both sides of the body.
  • Posttraumatic Arthritis: This form of osteoarthritis develops after an injury, such as a fracture or shoulder dislocation.
  • Rotator Cuff Tear Arthropathy: Develops after a large, long-standing rotator cuff tendon tear. The torn rotator cuff can no longer hold the head of the humerus in the glenoid socket, which causes the humerus to move upward and rub against the acromion. This can damage the surfaces of the bones, causing arthritis.
  • Avascular Necrosis: Occurs in the shoulder when the blood supply to the head of the humerus is disrupted. Because bone cells die without blood supply, this can ultimately lead to destruction of the shoulder joint and arthritis. This is caused by high dose steroid use, heavy alcohol consumption, sickle cell disease, traumatic injury or in some cases a cause is unidentifiable.

Symptoms of arthritis in the shoulder

  • Shoulder pain aggravated by activity and progressively worsens.
  • If the glenohumeral shoulder is affected, the pain is centered in the back of the shoulder and may intensify with weather.
  • If the acromioclavicular joint is affected, the pain is focused on the top of the shoulder and can radiate to the side of the neck.
  • Rheumatoid arthritis may have pain throughout the entire shoulder.
  • Limited range of motion.
  • Grinding, clicking or snapping sound when you move your shoulder.
  • Night pain is common, making sleeping difficult.

Physician examination

To determine whether you have arthritis of the shoulder, your physician will ask you for a complete medical history, have you describe your symptoms and conduct a physical examination. An X-ray may be necessary to rule out other problems.

Make an appointment with a shoulder specialist

Treatment for shoulder arthritis

To provide you with effective treatment, your physician will determine which joint is affected and what type of arthritis you have.

Nonsurgical Treatment: Initial treatment for arthritis of the shoulder is nonsurgical.

Surgical Treatment: Surgery may be necessary if your pain causes disability and is not relieved with nonsurgical methods.

Minor shoulder arthritis of the glenohumeral joint can sometimes respond to arthroscopic surgery with debridement of the joint; however, outcomes are less predictable. For advanced glenohumeral arthritis that fails conservative treatment, a shoulder replacement surgery is recommended. This involves replacing the ball and socket (humeral head and glenoid) joint. A reverse shoulder replacement (the ball is placed on the socket side and the socket is placed on the ball side) is sometimes indicated for rotator cuff arthropathy or bad proximal humerus fractures.

Rehabilitation

Shoulder replacement surgery typically involves an overnight stay at the hospital. Physical therapy is started to work on range of motion; however, restrictions are put in place to protect the soft tissue structures that are violated to enter the joint (one of the rotator cuff tendons {the subscapularis} is taken down to do the replacement then repaired at the end of the procedure). After six weeks patients progress to full range of motion and continue strengthening. Most patients have good function by four to six months; however, lifting restrictions are recommended.   

Learn more about shoulder treatment at OrthoIndy.

Schedule an Appointment Call OrthoIndy 317.802.2000
Megan Golden

By Megan Golden

Megan is the current marketing specialist for OrthoIndy. Megan graduated from Ball State University in 2012 with a bachelor’s degree in public relations and advertising and a communications studies minor and has been with OrthoIndy since then.

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