Shoulder arthritis, also referred to as glenohumeral 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 can also lead to loss of articular cartilage.
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 of 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.
The glenohumeral joint is where the head of the humerus fits into the scapula.
Types of shoulder arthritis
- Osteoarthritis: Also called “wear-and-tear” arthritis, this condition destroys the smooth outer covering of your bone. As the cartilage wears away it becomes frayed and rough, which causes the bones to rub against each other, causing pain.
- Rheumatoid arthritis (RA): RA is a chronic disease that attacks multiple joints throughout the body.
- Posttraumatic arthritis: This form of osteoarthritis develops after an injury, such as a fracture or shoulder dislocation.
- Rotator Cuff Tear Arthropathy: This develops after a 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: This occurs when the blood supply to the head of the humerus is disrupted. Because bone cells die without blood supply, this can 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
- Pain aggravated by activity and progressive worsening
- Pain throughout the entire shoulder (rheumatoid arthritis)
- Limited range of motion
- Grinding, clicking or snapping sound when you move your shoulder
- Pain while you sleeep
How is shoulder arthritis diagnosed?
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.
How is shoulder arthritis treated?
To provide you with effective treatment, your physician will determine which joint is affected and what type of arthritis you have.
Initial treatment for arthritis of the shoulder is nonsurgical.
- Rest or change in activity
- Strengthening exercises
- Physical therapy
- Non-steroidal anti-inflammatory medicine such as ibuprofen
- Corticosteroid injections
- Stem cell injection*
- PRP injection*
- Dietary supplements
*New studies show PRP and stem cell injections are an effective treatment to help ease pain caused by osteoarthritis. Ask your physician if you’re a candidate for these orthobiologics options. These injections are not guaranteed to take effect, but when they work, they will most likely decrease pain and improve function.
Surgery may be necessary if your pain causes disability and is not relieved with nonsurgical methods.
- Arthroscopic surgery: Minor shoulder arthritis of the glenohumeral joint may respond with this method, along with debridement of the joint.
- Shoulder replacement surgery: This involves replacing the ball and socket (humeral head and glenoid) joint.
- Reverse shoulder replacement: This is when ball is placed on the socket side and the socket is placed on the ball side. It is used for rotator cuff arthropathy or bad proximal humerus fractures.
How do you recover from shoulder arthritis?
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.
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.
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