What is Shoulder Joint Arthritis?
Arthritis is being diagnosed in more and more people every day with millions of people suffering from some type of arthritis. Arthritis is a condition where there is inflammation of one or more of the joints. In an arthritic shoulder, there is inflammation of the shoulder joint which causes pain and stiffness. Arthritis has no cure including shoulder joint arthritis; however, many treatment options are there to relieve the symptoms so that the patient can lead an active life without pain.
The shoulder joint has three bones. the humerus which forms the upper arm, the scapula which is the shoulder blade and the clavicle which is the collarbone. The head of the humerus bone attaches or fits into the rounded socket, which is known as glenoid present in the shoulder blade. A combination of tendons and muscles helps in keeping the bone of the arm fixed in the middle of the shoulder socket. These tissues are known as the rotator cuff. The shoulder has two joints and both of them can be affected by arthritis. One joint is the acromioclavicular, which is formed at the point where the tip of the shoulder blade meets the clavicle. The other joint is the glenohumeral joint, which is formed where the head of the humerus joins into the scapula.
It is important to determine which type of shoulder joint is affected and the type of arthritis which is affecting it to decide on the best course of treatment.
Types of Shoulder Joint Arthritis
There are 5 types of arthritis which affect the shoulder joint:
Shoulder Joint Osteoarthritis
This is a type of arthritis where there is "wear-and-tear" of the articular cartilage, which is the smooth outer covering of the bone. As this cartilage wears away, it becomes rough and frayed with reduction of the protective space present between the bones. During the shoulder joint movement, the bones rub against each other resulting in shoulder joint pain. Shoulder joint osteoarthritis commonly affects individuals who are above the age of 50 and is more commonly seen in the acromioclavicular joint than the glenohumeral shoulder joint.
Shoulder Joint Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disease and a chronic condition which affects multiple joints all over the body. In this disease, the body’s immune system starts attacking the body’s own tissues. The defense mechanism of the body, which is responsible for protecting the body from infection, damages the normal tissue of the body including the ligaments and cartilage, which results in softening of the bone. RA is symmetrical in nature, i.e. it commonly affects the same joint on both the sides of the body. There is a lining, which covers the joints of the body known as synovium. This helps in lubrication of the joint and makes movement of the shoulder joint easier. In rheumatoid arthritis, there is swelling of this lining, which causes stiffness and pain in the shoulder joint. Rheumatoid arthritis affects both the shoulder joints equally.
Rotator Cuff Tear Arthropathy
Previous old rotator cuff tendon tear can also lead to development of shoulder joint arthritis. The rotator cuff which is torn will not be able to hold the humerus head in the glenoid socket resulting in the upward movement of the humerus and its rubbing against the acromion. This causes damage to the surfaces of the bones resulting in shoulder joint arthritis. Large rotator cuff tear along with advanced arthritis causes weakness and severe pain in the patient due to which he/she is not able to lift their arm away from the side.
Posttraumatic Should Joint Arthritis
Posttraumatic arthritis is a type of osteoarthritis, which develops after a trauma or injury to the shoulder joint, such as dislocation of the shoulder or fracture of the shoulder.
When there is disruption in the blood supply to the head of the humerus it results in avascular necrosis (AVN) of the shoulder, which is a very painful condition. The bone cells die from the lack of blood supply leading to destruction of the shoulder joint and ultimately arthritis of the shoulder joint. The development of avascular necrosis takes place in stages. As this condition worsens, there is gradual collapsing of the dead bone, resulting in damage to the articular cartilage, which covers the bone and leads to arthritis of the shoulder joint. In the initial stage, AVN only affects the head of the humerus, however, as the condition deteriorates, there is damage to the glenoid socket caused from the collapsed head of the humerus. Some of the causes of AVN include excessive alcohol use, sickle cell disease, excessive dose steroid use, and traumatic injury including shoulder fractures. There are some cases, where no cause of AVN can be identified; then it is referred to as idiopathic AVN.
Signs & Symptoms of Shoulder Joint Arthritis
- Pain is a common symptom of shoulder joint arthritis. This pain gets aggravated with activity or movement and worsens progressively.
- If the acromioclavicular (AC) joint is involved in shoulder joint arthritis, then the pain is centered on the top of the shoulder. Pain can also radiate to the lateral side of the neck.
- If the glenohumeral shoulder joint is involved, then the pain is felt in the back of the shoulder and exacerbates with weather changes. There is also pain felt deep in the shoulder joint.
- The pain of rheumatoid arthritis of the shoulder joint is felt throughout the shoulder, if both the AC and glenohumeral joints are affected.
- Patient has limited range of motion, which is another common symptom of shoulder joint arthritis. Patient suffering from shoulder joint arthritis finds difficulty in lifting the arm for overhead activities, such as reaching up to a shelf or combing their hair.
- Crepitus is heard upon movement of the shoulder joint, which is a clicking, grinding or a snapping sound, this could be a sign of shoulder joint arthritis.
- As the shoulder joint arthritis worsens, any type of movement of the shoulder causes a lot of pain. Patient also feels pain during the night which makes sleeping difficult.
Diagnosis of Shoulder Joint Arthritis
Medical History and Physical Examination of the patient is taken where the patient’s symptoms are discussed and the doctor examines the shoulder joint and looks for the following:
- Tenderness to touch.
- Atrophy or weakness of the muscles.
- Pain upon pressure on the shoulder joint.
- Range of motion of the shoulder joint where the extent of active (self-directed) and passive (assisted) motions are assessed.
- Signs of any previous injuries to the shoulder joint.
- Signs of injury to the tendons, muscles and ligaments, which surround the shoulder joint.
- If there is involvement of other joints, such as seen in rheumatoid arthritis.
- Crepitus, which is a grating sensation felt inside the joint upon shoulder joint movement.
X-Rays are taken of the shoulder joint to get detailed pictures of the bones to help differentiate between different types of arthritis. X-rays taken of an arthritic shoulder joint will reveal changes in the bone, narrowing of the joint space, and formation of osteophytes (bone spurs).
For confirmation of diagnosis of shoulder joint arthritis, a local anesthetic is injected into the shoulder joint. If there is temporary relief of the pain, then the diagnosis of arthritis is established.
Nonsurgical Treatment of Shoulder Joint Arthritis
Nonsurgical or conservative treatment of should joint arthritis is the first line of treatment as is also done in other arthritic conditions. The following treatment options are recommended:
Rest: Rest is important to relieve the pain or patient should modify his/her activities and avoid those activities which trigger pain. The way the patient moves his/her arm for doing daily work may need to be changed.
Physical Therapy Treatment for Shoulder Joint Arthritis: Physical therapy exercises are beneficial in improving the range of motion of the shoulder joint along with improving flexibility and strength of the shoulder muscles.
NSAIDS: Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or aspirin help in alleviating pain and inflammation. However, these medications can cause irritation to the stomach lining leading to internal bleeding and should always be taken with food. Always consult the doctor before starting any type of over-the-counter NSAIDs, especially if the patient has history of ulcers or if the patient is taking blood thinning medications.
Injections: Corticosteroid injections given in the shoulder joint help greatly in reducing the pain and inflammation of the shoulder joint. However, their effect is usually temporary and patient may need to take the injections again for relief.
Heat/Cold Therapy for Shoulder Joint Arthritis: Moist heat or icing of the shoulder joint for about 20 minutes, three times daily also help in reducing pain and inflammation associated with shoulder joint arthritis.
DMARDS: If the patient is suffering from rheumatoid arthritis, then disease-modifying anti-rheumatic drugs, such as methotrexate can be prescribed.
Supplements: Glucosamine and chondroitin sulfate, which are dietary supplements, also help in relieving pain associated with shoulder joint arthritis. However, it is important to always consult your doctor before starting on any dietary supplements, as these can interact with other medicines.
Surgical Treatment of Shoulder Joint Arthritis
Surgery is considered if the nonsurgical treatment does not provide relief and the pain from the shoulder joint arthritis is causing disability in the patient where he/she is not able to perform daily activities of living. The following are the surgical options for treating Shoulder Joint Arthritis:
Arthroscopy can be done for treating mild cases of glenohumeral arthritis. In this procedure, an arthroscope, which is a small camera, is inserted into the shoulder joint. This camera generates pictures on a television screen, which help the surgeon in guiding the miniature surgical instruments. Very small cut or incisions are made as the surgical instruments and the arthroscope are thin. During arthroscopy, the surgeon also debrides the internal region of the joint. This procedure provides relief from the pain; however, it does not eliminate or cure arthritis from the shoulder joint. If there is worsening of the arthritis, then patient may need further surgery in the future.
Arthroplasty or Shoulder Joint Replacement is done in advanced or severe cases of glenohumeral shoulder joint arthritis. In this procedure, the damaged parts of the shoulder are removed and replaced with prosthesis which is the artificial component.
Some of the Options for Replacement Surgery are:
Hemiarthroplasty is a procedure where only the head of the humerus is replaced by the prosthesis.
Total Shoulder Arthroplasty for shoulder joint arthritis is a procedure where both the glenoid and the head of the humerus are replaced. A metal "ball" is fastened to the top of the humerus and a plastic "cup" is attached into the glenoid cavity.
Reverse Total Shoulder Arthroplasty to treat shoulder joint arthritis is a surgical procedure, which is opposite to total shoulder arthroplasty. Here the metal ball is attached to the glenoid and the plastic cup is fastened to the upper end of the humerus. This procedure is recommended in patients with rotator cuff tear arthropathy, as it uses different muscles to move the arm.
Resection Arthroplasty is the common surgical procedure used for treating acromioclavicular joint arthritis. This procedure can be done arthroscopically. In this procedure, the surgeon removes a small part of the bone from the end of the collarbone which leaves a space that fills with scar tissue over the time.
Recovery & Complications from Surgery for Shoulder Joint Arthritis
Surgical treatment of shoulder joint arthritis is often very effective in reducing the pain and restoring range of motion of the shoulder joint. The recovery time and rehabilitation from shoulder joint surgery depends on the type of surgery performed. Complications of surgery for shoulder joint arthritis are the same as of other surgeries. Potential complications of surgery for shoulder joint arthritis include excessive bleeding, infection, blood clots and damage to nerves or blood vessels.
Future Studies in Shoulder Joint Arthritis
- Studies are being done for shoulder joint arthritis and its treatment. In most of the cases, the exact cause of arthritis and why some people develop it and some don’t is not known. Research is being done to find out the causes of shoulder joint arthritis.
- The efficacy of biologic materials for resurfacing of an arthritic shoulder is also being studied. Biologic materials are the tissue grafts, which help in promoting new tissue growth in the body to assist in the healing process.
- Further research is also going on for shoulder joint replacement surgery, such as development of different prosthesis designs for the shoulder joint.
- The use of efficacy of joint lubricants on shoulder joint is being studied. Investigations are going on for new medications for treating rheumatoid arthritis.