Shoulder Arthritis: A Basic Guide, Part One

The shoulder joint is where the humerus bone of the upper arm connects with the glenoid – the socket on the side of the shoulder blade. Shoulder arthritis happens when the cartilage between the humerus and the glenoid breaks down, causing bone-on-bone contact. This leads to irregular motion in the joint, inflammation, pain and limited mobility.

Symptoms

The most common symptom of any kind of shoulder arthritis is pain. People often describe a deep pain that gets worse with activity and better with rest. The pain is usually worse with overhead activities like throwing a ball, washing your hair or reaching for something in a top cupboard. The second most common symptom is a loss of movement in the shoulder. Other symptoms may include:

• Weakness
• A grinding sensation or sound (called crepitus)
• Difficulty using the affected arm
• In more advanced stages of shoulder arthritis, many patients report pain at night that interferes with sleep.

Causes

Osteoarthritis, or degenerative arthritis, is generally caused by a deterioration of cartilage over time from the normal aging process. Cartilage is the smooth, shiny white covering on the end of bone that keeps the bones from rubbing together. It acts as a lining to the joint. It is very thin (3 mm or less, depending on the joint) and unable to heal once injured. The normal wear and tear of life or the brisk tempo of sports can gradually wear it down.

Furthermore, the development of osteoarthritis can be from many other factors. Many people have a genetic predisposition to develop arthritis over their lifetime.

Diagnosis

In order to diagnose shoulder arthritis, a physician will ask the patient about their symptoms and medical history and perform a physical examination. Typically, patients with advanced arthritis will be unable to elevate their arm to the level of the shoulder and have limited rotation of their arm away from their body. X-rays can be used to evaluate and confirm the degree of arthritis and the amount of bone loss. An MRI and CT scan may also be needed.

Nonsurgical treatment options

Shoulder arthritis treatment depends on:

• What kind of arthritis is present
• Which joint(s) is/are affected
• How disabling and painful the disease is

Arthritis treatments are aimed at reducing pain and restoring motion. Some of the treatments available include:

Physical Therapy

The first line of treatment for shoulder arthritis is physical therapy. Although physical therapy cannot replace any of the damaged cartilage, it may help to improve pain and movement. A physical therapist may recommend specific stretches for muscles and ligaments to restore some motion and offer pain relief. A therapist may also use manual therapy to stretch the ligaments, tendons and muscles in ways that are difficult to do on your own. Physical therapy will also focus on strengthening the muscles to better hold the shoulder joint in the socket and assist with movement.

Pain Control

Pain management is an important part of coping with shoulder arthritis. It may include:

• Ice: Ice packs can be used once or several times a day for 20–30 minutes at a time to reduce painful inflammation.
• Heat: Some people prefer heat for shoulder arthritis pain. Heat may be especially helpful to use for warming up the joint before stretching.
• Medication: All medications have benefits and potential complications. Common medicines include acetaminophen (Tylenol) and NSAIDs (e.g., Advil or Motrin). Opioid (narcotic) medications should be avoided as they are highly addictive and become less effective over time, especially if surgery is chosen.
• Injections: Injections can effectively treat the inflammation caused by shoulder arthritis, which alleviates pain and allows for improved range-of-motion. Options include cortisone injections and orthobiologics. Cortisone injections are often suggested – along with physical therapy – early in the treatment plan to manage arthritis as they can offer significant pain relief with minimal side effects. Orthobiologics, which use a patient’s own blood and cells, are much newer treatments that may provide similar results as cortisone injections but are typically more expensive.

Surgical Options:

Most are performed on an outpatient basis, meaning you can go home the same day after the surgery. They vary from very minimally invasive techniques (Arthroscopic surgery, where the use of a small camera and instruments clean the shoulder), to actual replacement of the damaged joint, also known as shoulder replacement surgery or shoulder arthroplasty.

FAQs

What parts of the shoulder can be affected by arthritis?

Arthritis can affect any of the three shoulder joints: the glenohumeral (GH) joint, the acromioclavicular (AC) joint and occasionally the sternoclavicular (SC) joint. When any kind of arthritis affects the shoulder joint, cartilage on one or both sides of the joint start to wear out.

Acromioclavicular (AC) joint: This joint is where the clavicle (collar bone) meets the acromion (roof of the shoulder), which is part of the scapula (shoulder blade). It moves a little when the shoulder moves and can be injured in a shoulder separation. Arthritis of the AC joint is very common. In fact, after 40 years of age, most people will have AC joint osteoarthritis on their shoulder x-rays. For most people, there is no significant pain, so no treatment is necessary, even with abnormal X-rays. Persistently painful AC joint arthritis that limits the use of the shoulder is uncommon.

Glenohumeral (GH) joint: This larger joint is the ball and socket joint connecting the top part of the arm (humerus) to the shoulder blade (scapula). It allows the shoulder to have a wide range of motion in all directions. In the course of a lifetime, this joint is constantly in motion. When arthritis develops, it restricts motion and causes pain. Since the shoulder helps position the hand for daily functions, sports and other activities, any loss of motion or restriction because of pain will significantly limit the function of the entire arm and hand.

Are there different types of arthritis?

There are more than 100 types of arthritis! However, the majority of arthritic conditions affecting the shoulder are often separated into two major categories:

Osteoarthritis (OA): This is the “wear and tear” type of arthritis that often appears in later life. In some cases, OA can present after an injury or fracture (break) to the shoulder and is called post-traumatic arthritis.

Inflammatory arthritis: This includes rheumatoid arthritis (RA) and affects people at an earlier age. It typically affects multiple joints in the body (elbows, shoulders, knees, etc.) and is caused by an underlying inflammatory autoimmune disease.

Shoulder Arthritis: A Basic Guide, Part Two

Coming next month: Shoulder Arthritis, A Basic Guide, Part Two. If you are thinking about shoulder replacement surgery, We’ll discuss what questions you should be asking yourself and your surgeon. FBN

By Yuri Lewicky, M.D.

Dr. Yuri Lewicky, M.D., is a double board-certified Orthopaedic Surgeon who specializes in shoulder surgery and sports medicine. He practices in Flagstaff and Prescott Valley at Northern Arizona Orthopaedics and can be reached at 928-226-2900, NorthAzOrtho.com