Shoulder osteoarthritis, chondrolysis, rheumatoid arthritis, degenerative joint disease, and arthritis after shoulder arthroscopy and open surgery
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Saturday, July 05, 2008
Figure 3 - Glenoid bone spurs: The figure on the left shows bone spurs at the bottom of the joint. The figure on the right shows that the ball is not centered and has worn down the back part of the socket. Review of the conditionWhat are the different types of shoulder arthritis? Rheumatoid arthritis, arthritis after injury (traumatic arthritis), arthritis after previous surgery (for example, capsulorrhaphy arthropathy), and arthritis associated with rotator cuff disease (known as cuff tear arthropathy). Arthritis may also follow infection; this is known as septic arthritis. If the ball of the shoulder joint (humeral head) dies from lack of circulation, a condition known as avascular necrosis of the shoulder may result.What else might be confused with or similar to shoulder arthritis? How can these be distinguished from the condition? Shoulder arthritis must be distinguished from rotator cuff disease,
frozen shoulder, and neck arthritis, each of which may produce similar
symptoms. Rotator cuff tears usually cause pain and weakness, but
stiffness is less common. Frozen shoulder is characterized by shoulder
stiffness, but the X-rays are usually normal. Neck arthritis may cause
shoulder pain and weakness that is worse when the head is held in
certain positions.
How common is shoulder arthritis (statistics, demographics, risk factors)? While not as common as rotator cuff disease, shoulder arthritis is
among the most prevalent causes of shoulder pain and loss of function.
Arthritis of the shoulder joint is less common than arthritis of the
hip or knee. Individuals with arthritis in one joint are more likely to
get it in another joint.How is shoulder arthritis diagnosed? What tests or exams may be used? A physician diagnoses shoulder arthritis by reviewing the patient's
history, performing a thorough physical examination of the joint and
taking the proper X-rays. The examination of an arthritic shoulder
reveals stiffness and roughness of
the joint.
X-rays of the shoulder reveal the contour of the joint surfaces and
the status of the cartilage space between them. X-rays of an arthritic
shoulder usually show a narrowing of the space between the ball and
socket--often to the point that bone is touching bone. The left side of
figure 3 shows bone spurs at the bottom of the joint. The right side of
figure 3 shows that the ball is not centered and has worn down the back
part of the socket. These findings indicate that the normal cartilage
has been destroyed. X-rays do not show the soft tissues, such as scar
tissue, that may also be limiting joint motion.
It is essential that the shoulder surgeon establish the diagnosis of arthritis before shoulder joint replacement is considered.
Can medications help shoulder arthritis? Medications may be helpful in managing arthritis. In the case of
rheumatoid arthritis, specific drugs may treat the inflammation that
destroys the cartilage. Some of these medications are administered by
injection and others by mouth. Some individuals take anti-arthritic
medications for their entire lives. These medications can be quite
helpful, but there may be side effects. These medications should be
taken under the close supervision of a rheumatologist or other
physician experienced in their use. In other types of arthritis,
anti-inflammatory drugs may lessen the pain, but do not change the
course of the condition. It is important that the patient be aware of
the possible side effects of these medications, including stomach
irritation, kidney problems and bleeding. Injections of steroids
(cortisone) or lubricants (such as hyaluronic acid) into the shoulder
have not been demonstrated to have lasting benefit and carry some risk
of infection.
For each medication, patients should learn:
- the risks,
- possible interactions with other drugs,
- the recommended dosage, and
- the cost.
Can exercises help shoulder arthritis? If exercises are not too painful, they may be helpful in maintaining
the flexibility and strength of joints with arthritis. In most cases
these exercises can be done in the patient's home with minimal
equipment. Shoulder exercises are best performed gently several times a
day on an ongoing basis. Often the exercises will help during the
earlier phases of the condition. The exercises are not dangerous if
they are performed gently. The diagrams show two examples of these
exercises.
Figure 4 shows a patient using the left arm to help lift the stiff
right shoulder in a forward direction. Figure 5 shows a patient using
the left arm to gently stretch the stiff right arm in external rotation
using a yardstick.
Sometimes other types of therapy are used by physical therapists.
Patients should learn the possible risks of these approaches as well as
their costs and anticipated effectiveness. Specifically, how is shoulder arthritis improved by shoulder replacement surgery? When combined with a good rehabilitation effort, shoulder joint
replacement arthroplasty allows arthritic shoulders to regain some of
their lost comfort and function. In experienced hands, this procedure
can address the restricting scar tissue that frequently accompanies
arthritis. It can also restore smooth, stabilizing joint surfaces when
these surfaces have been damaged by arthritis.
Joint replacement surgery can improve the mechanics of the shoulder,
but cannot make the joint as good as it was before the onset of
arthritis. In many cases, the tendons and muscles around the shoulder
have been weakened from prolonged disuse before the shoulder
replacement. The scar around them needs to be removed. After the
surgery, it may take months of gentle exercises before the shoulder
achieves maximum improvement.
The effectiveness of the procedure depends on the health and
motivation of the patient, the condition of the shoulder, and the
expertise of the surgeon. When performed by an experienced surgeon, the
published literature shows that shoulder replacement arthroplasty
usually provides improved shoulder comfort and function. The greatest
improvements are in the ability of the patient to sleep, to perform
activities of daily living, and to perform non-contact recreational
activities.
Total shoulder joint replacement for shoulder arthritis
Surgery for shoulder arthritis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-7416 to make an appointment.
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