What is shoulder arthritis?
Osteoarthritis, also known as “wear and tear” arthritis, is a condition that erodes the smooth lining (articular cartilage) of a joint. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. During movement, the bones of the shoulder joint rub against each other, causing pain.
Osteoarthritis usually affects people over 50 years of age and is common in the glenohumeral (ball and socket) shoulder joint and the acromioclavicular (end of collar bone) joint.
There are other forms of arthritis that can affect the shoulder joint. This includes rheumatoid, post-traumatic and rotator cuff tear arthritis.
Rheumatoid arthritis is an inflammatory process that affects the lining of the joint causing swelling and pain. Post-traumatic arthritis can occur after fractures of the upper arm bone or dislocation of the shoulder joint.
Rotator cuff tear arthritis occurs after large, long standing rotator cuff tendon tears. The torn rotator cuff can no longer hold the ball of joint firming in the socket, causing it to rub up and down. This can damage the surfaces of the joint, causing arthritis in shoulder to develop.
What are the symptoms of shoulder arthritis?
The most common symptom of arthritis of the shoulder is pain, which is aggravated by activity and progressively worsens.
If the glenohumeral (ball & socket) shoulder joint is affected, the pain can be felt all around the shoulder spreading into the upper arm. The pain is often worse and the shoulder more stiff to move first thing in the morning.
The pain of arthritis in the acromioclavicular (AC) joint is focused on the top of the shoulder at the end of the collarbone. This pain can sometimes radiate or travel to the sick of the neck.
Someone with rheumatoid arthritis may have pain throughout the shoulder is both the glenohumeral and AC joints are affected.
Limited range of motion is another common symptom. It may become more difficult to lift your arm to comb your hair or reach up to a shelf. You may hear a grinding sound (crepitus) or shoulder clicking as you move your shoulder.
As the disease progresses, any movement of the shoulder causes pain. Shoulder pain at night is common and sleep may be difficult.
What are options for shoulder arthritis treatment?
As with other arthritis, initial treatment of shoulder arthritis is non operative. This includes activity modification to avoid provoking pain. Anti-inflammatory medication including pain killers and shoulder injections may help reduce the inflammation and pain.
Surgical shoulder treatment is an option once non-surgical options measures have failed.
Shoulder arthritis and arthroscopy keyhole surgery
In cases of mild glenohumeral arthritis, an option is arthroscopy keyhole surgery. During arthroscopy, a small camera called an arthroscope is introduced into the shoulder joint. The camera displays a picture on a digital display, and the shoulder surgeon specialist uses these images to guide miniature surgical instruments. Because the arthroscope and surgical instruments are thin, the surgeon can use very small cuts, rather than the larger incisions needed for standard, open surgery.
During the procedure, the shoulder surgeon can debride (clean out) the inside of the joint. Although this procedure can provide pain relief, it will not eliminate the arthritis from the joint. If the arthritis progresses, further surgery may be need in the future.
AC joint arthritis is common and is treated by removing a small amount of bone from the end of your collarbone. This can be done through keyhole surgery.
In more advanced stages of arthritis, patients may need other surgical treatments such as a shoulder replacement.
What is a shoulder replacement?
Advanced arthritis of the glenohumeral joint can be treated with shoulder replacement surgery, in which the damaged parts of the shoulder are removed and replaced with artificial components made from metal and plastic.
Replacement surgery options include conventional total shoulder replacement or reverse shoulder replacement.
Total shoulder arthroplasty – this requires normal rotator cuff tendons and a good amount of bone remaining in the shoulder. Both the ball and the socket are replaced. A plastic “cup” is fitted into the socket, and a metal “ball” is attached to the top of the arm.
Reverse total shoulder replacement – this is used in patients with torn rotator cuff tendons to allow them to use other muscles to raise their arm and use their shoulder. In this type of replacement, the socket and metal ball are the opposite way around compared to a conventional total shoulder replacement.
Shoulder replacement surgery recovery
Shoulder replacement surgery is generally very effective in reducing pain and restoring motion. Recovery time depends upon the type of surgery performed, but typically patients need to wear a sling for four weeks and it often takes at least three months of shoulder replacement rehab to settle to a comfortable level.
What are shoulder replacement surgery complications?
As with all surgeries, there are some risks and possible complications. Potential problems could include infection, excessive bleeding, blood clots and damage to blood vessels or nerves. Particular with shoulder replacement surgery, the artificial joint may wear and loosen over time, which may require further shoulder surgery in the future.
We will discuss the possible complications with you before your operation.
If you think you may be experiencing shoulder arthritis, contact our Melbourne Arm Clinic staff.