What is Shoulder Arthritis?
Arthritis is inflammation of the shoulder joint. It can occur in any of the three joints of the shoulder, the glenohumeral, acromioclavicular (AC), or sternoclavicular joint. Arthritis leads to the loss of articular cartilage, which covers the ends of the bones, and allows the bones to move smoothly against each other. When the cartilage is damaged or decreased, the bones rub together during joint motion, and the patient is said to have ‘bone-on-bone’ in the joint. This can lead to pain with motion, or at rest, clicking or grinding with motion, and a loss of strength. When arthritis becomes severe, the body attempts to stabilize the joint and limit motion by forming bone spurs, or extra bone around the edges of a joint.
What causes Shoulder Arthritis?
There are two main types of arthritis: rheumatoid and osteoarthritis. Rheumatoid arthritis occurs when the body’s immune system causes the inflammation; osteoarthritis occurs when the joint wears out as a result of overuse, age, or injury. When an infection in the joint leads to loss of cartilage, it is called septic arthritis.
What are the symptoms?
People suffering from shoulder arthritis in the glenohumeral joint will experience pain, stiffness and loss of strength. A ‘grinding’, ‘clicking’ or ‘locking’ sensation may be felt in the affected joint. Loss of motion can become severe, and the patient may have trouble performing everyday tasks, such as placing object on shelves or combing their hair.
Patients suffering from arthritis of the AC joint will often notice a bump on top of the joint. This bump also extends downward on the inside of the shoulder and pushes into the top of the rotator cuff. For this reason, AC arthritis will often lead to rotator cuff symptoms, such as pain in the arm over the deltoid, night pain, and difficulty lifting objects overhead.
If arthritis occurs in the sternoclavicular joint, a painful tender bump will be found over the joint. This swelling can occur rapidly leading to a visible deformity, causing most patients to become alarmed.
How is Shoulder Arthritis diagnosed?
Arthritis is diagnosed on physical exam and X-ray. Your orthopaedic surgeon will examine your shoulder, noting range of motion, strength and pain with motion. Your surgeon will obtain x-rays, and sometimes a CAT scan or MRI to evaluate the arthritis.
How is it treated?
Shoulder arthritis can be treated with physical therapy, to strengthen the muscles that support the joint. The stronger the supporting muscle, the less the body will need to rely on bony architecture to stabilize the joint. This will lead to less stress across the arthritic area. Because arthritis is inflammation, your surgeon may prescribe anti-inflammatory medication or offer an injection to reduce the inflammation. For arthritis in its beginning stages, nutritional supplements are available to slow progression of the arthritis. An injection of the patient’s own blood, which is processed to enhance its healing properties, has shown promise for treating arthritic conditions.
When non-operative treatment has failed, your surgeon may suggest surgery. Three surgical options are available for glenohumeral arthritis. Arthroscopy of the shoulder, or a ‘shoulder scope’, involves placing a tiny camera in the joint to visualize and remove injured cartilage. Although not a cure, this procedure may provide long lasting relief. For more severe cases, a total, or partial shoulder replacement may be offered. This involves removing the joint and replacing the injured cartilage with a smooth metal or plastic implant. This allows the shoulder to move smoothly, reducing pain and in many cases, improving motion.
For AC arthritis, the surgeon will remove the arthritis arthroscopically and widen the joint. This prevents the collarbone from contacting the shoulder blade and eliminates pain from the joint.
Surgery is rarely necessary for sternoclavicular arthritis as pain relief is usually accomplished with non-operative treatment. If surgery is required, your surgeon will widen the joint to prevent the collarbone from contacting the sternum, eliminating pain from the joint.