Shoulder Arthritis

The term arthritis means inflammation of a joint and is associated with cartilage damage. Cartilage is a cushioned padding lining the bones that make up a joint in order to absorb stress during movement. Damage of the cartilage in the shoulder joint causes shoulder arthritis. When the cartilage gets damaged, the raw bones begin to painfully rub against each leading to inflammation. Instead of the super smooth surfaces our joints have when we are born, they begin to soften, then crack and fissure and ultimately expose the bone beneath the surface. This causes pain and deformity. Depending upon the joint involved and the amount of destruction and pain, surgery may be required to provide pain relief and improvement in function. The proportion of cartilage damage inflammation varies with the type and stage of arthritis. The most common types of arthritis are:

Osteoarthritis:

Osteoarthritis, also called wear-and-tear arthritis is a degenerative joint disease that affects the cartilage. The cartilage starts to wear away over time, and in extreme cases, nothing remains to protect the bones, causing painful bone-on-bone contact. Osteoarthritis is the most common type of arthritis, which often occurs with advanced age, excessive strain, or other diseases, injury, or deformity. Since our shoulders hang from our bodies, arthritis is better tolerated in the shoulder and typically does not become a severe problem until much more destruction of the joint has taken place than what we could tolerate in our hips or knees.

Rheumatoid arthritis:

This is an auto-immune disease in which the body’s immune system attacks healthy joints. Occurring most often in women of childbearing age (15 to 44 years), this disease inflames the lining of joints (synovium). Rheumatoid arthritis mostly affects joints of the hands and feet and tends to be symmetrical (affects the same joints on both sides of the body).

Arthropathy and Inflammatory Arthritis:

Another form of arthritis that affects the shoulder is called rotator cuff arthropathy. This is arthritis that results when someone has had a large rotator cuff tear for a long time. Patients with this condition are more likely to require a reverse total shoulder replacement. Arthritis that occurs after an injury is called post-traumatic arthritis. Some people have a chronic inflammatory arthritis that may affect many joints in the body. Types of inflammatory arthritis include rheumatoid arthritis, psoriatic arthritis and many others.

The type of arthritis you have, the extent of damage to your joint, your age and rotator cuff integrity will all affect the surgical and non-surgical options to treat your shoulder pain and dysfunction. Sometimes a short course of an anti-inflammatory medication or a “cortisone shot”, and heat or ice will be all that is necessary to relieve the discomfort from an acute flare of arthritis. Typically, you should avoid repetitive lifting or heavy lifting with the affected shoulder. An isometric strengthening and flexibility program may help improve strength and range of motion of your shoulder and alleviate pain.

Each form of arthritis affects the shoulder differently, with general symptoms including swelling and pain or tenderness for more than two weeks, redness or heat, limitation of motion, and early morning stiffness. When severe, arthritis can deform or cause disability in the shoulder joint. In an arthritic shoulder:

• The capsule is swollen.
• The joint space is narrowed and irregular in outline.
• Bone spurs or excessive bone can also build up around the edges of the joint.

Doctors diagnose shoulder arthritis with your medical history, a physical exam, and X-rays of the affected part. Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans may also be performed to diagnose arthritis.

There is no cure for arthritis, but the symptoms can be managed. Your doctor may prescribe pain and anti-inflammatory medicine, and advice ice application, rest and occupational therapy or physiotherapy, which includes exercises and heat treatment. To reduce pain, your doctor may administer a steroid injection directly into your joint. In severe cases, surgery may be suggested. Common surgeries for treatment of shoulder arthritis include arthroplasty (replacement of the damaged joint with artificial components) and arthroscopy (using narrow instruments and small incisions to clean out the damaged tissue).

Further Reading

Shoulder Arthritis and Shoulder Replacement

Why Sleeping on Your Side Is Killing Your Shoulder