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Osteoarthritis

The shoulder is made up of two joints, the acromioclavicular (AC) joint where the collarbone (clavicle) and shoulder blade (scapula) meet and the glenohumeral (GH) joint where the upper end of the humerus and scapula form a ball and socket joint. Both can be affected by arthritis.

The types of arthritis that can affect the shoulder joint can be grouped into three categories.

Osteoarthritis: wear and tear or age related arthritis, which progressively destroys the smooth outer covering (articular cartilage) of the shoulder bones. The normally smooth joint surfaces become rough and irregular. This is more commonly seen in people aged over 50 years, affecting both men and women.

Post traumatic arthritis: a form of osteoarthritis, which typically develops following an injury to the shoulder such as a fracture, repeated dislocations or rotator cuff tears.

Rheumatoid arthritis: an inflammatory disease affecting the joint lining leading to progressive destruction of the surface of joints not only in the shoulder but knees, hips, elbows, hands and feet. This disabling disease can affect people of any age.

Symptoms

  • Joint pain is the most common symptom of arthritis.
  • Most people describe a gradual reduction in the range of shoulder mobility as the disease progresses.
  • Activities such as lifting the arm above the head becomes most uncomfortable and may be accompanied by creaking or clicking in the joint.
  • Many people experience night pain and the inability to sleep as arthritic changes advance.
  • Arthritis in the GH joint will produce pain that is centralised towards the back of the shoulder.
  • If the AC joint is affected, pain is more commonly found towards the front of the shoulder.
  • Those with rheumatoid arthritis may have generalised pain affecting one or more joints in the body.

Diagnosis

A physical examination is the first stage of diagnosing arthritis in the shoulder joints. X-rays will be taken routinely to examine joint space and reveal if bony spurs or osteophytes have formed at the ends of the bones as a result of arthritic changes.

Treatment

Conservative measures such as rest and avoiding activities that cause pain are usually the first steps in treating arthritis of the shoulder.

Non-steroidal anti-inflammatory medications are often used to reduce inflammation in the joint.

Icing the joint 3-4 times per day has also proven to assist with pain and swelling.

Surgical treatment for shoulder arthritis is usually discussed when conservative management does not reduce pain.

Your Doctor will discuss with you the surgical options available. He or she will also discuss the likely outcome and any related risks and complications so you can make a balanced decision.

The type of surgery recommended would depend on which part of your shoulder joint is affected by arthritis. Where the glenohumeral (GH) joint is affected a total shoulder arthroplasty replaces both the humeral head and the socket joint or glenoid with artificial components.

A hemiarthroplasty replaces only the humeral head leaving the healthy glenoid in tact. An open incision is used in both surgical procedures.

A metal component is used to replace the head of the humerus. This metal alloy ball is on a stem that fits down into the arm bone. The glenoid component replaces the socket part of the joint and is most commonly made of plastic. Some components are cemented in place using special bone cement while others have a rough, porous surface into which the bone grows to lock the implant in place.

Your surgeon will discuss with you, the type of components that will be best for your surgery. A physical therapy/ exercise program designed to restore joint function, strength and mobility always accompanies shoulder replacement surgery.

Arthritis of the acromioclavicular (AC) joint can be treated by resecting the joint – called resection arthroplasty. Arthroscopic removal of the tip of the clavicle removes the pain caused by the rubbing together of the rough ends of the clavicle and the acromion. Scar tissue forms in place of the removed bone and the function of the joint is restored.

A particularly nasty arthritis can develop in a shoulder that has lost its rotator cuff tendons, called “cuff arthropathy”. Although treatment with a replacement can help with pain, use of the joint remains limited.