What is shoulder arthritis? Arthritis is a condition that occurs in various joints in the body, especially in the knees, hips and spine. It can affect any joint, but the shoulder is affected infrequently. When shoulder arthritis occurs, the cartilage that covers the ends of the bones making up the joint breaks down, and often flakes off into the joint. The joint then becomes swollen and stiff, and the lining tissue of the joint becomes overgrown. Frequently, spurs will develop around the margins of the joint and can sometimes break off inside.
The pain can vary from mild to very severe, depending upon many factors - including the severity of the disease, the type of arthritis (most are “wear and tear” or degenerative arthritis, but some are caused by rheumatoid disease) and the individual’s activity level.
Who usually gets arthritis? Anyone can develop arthritis, but it most often occurs in middle-aged and senior patients.
The condition may occur spontaneously or as a result of previous trauma, such as fracture or dislocation. It may also occur as a result of inflammatory conditions, such as rheumatoid arthritis.
How do I know if I have arthritis of the shoulder? The shoulder joint becomes stiff, feels heavy and fatigues easily when arthritis is present. The stiffness is usually worse in the morning, and can slowly improve with warm-up activities. Also, grinding and catching in the shoulder is a common sign of arthritis in that joint.
What tests can the doctor do to prove that shoulder arthritis is present? Most advanced cases of arthritis can be diagnosed with an x-ray evaluation of the shoulder. Sometimes, with rheumatoid or other types of inflammatory arthritis, special bloods tests or other evaluations are needed.
What is the best treatment for arthritis of the shoulder? The treatment of shoulder arthritis depends on how disabling and painful the disease is. Often your doctor will refer you to a rheumatologist who specializes in treating arthritis with medications. Physical therapy, particularly hydrotherapy (exercises done in a swimming pool), is very soothing. It helps maintain or regain range of motion of the joint and strengthens the surrounding muscles. If the arthritis is advanced, causing severe pain and disability, your doctor may consider surgery. Some early arthritis can be treated with arthroscopic (microsurgical) techniques. With this procedure, the doctor trims out the inflamed synovial lining tissue and removes debris and pieces of degenerated cartilage. Of course, this will not cure the arthritis, but frequently relives many of the symptoms – at least temporarily. With severe disease, the only surgical treatment is joint replacement. This brings dramatic pain relief and often restores some motion, but it has its limitations. The joint surfaces are surgically replaced though a five-inch incision in the front of the shoulder, and a metal ball and plastic socket are inserted.
If total shoulder joint replacement is needed, what are some of the risks? The risks of total shoulder replacement are those of any standard surgical procedure, and include infection, anesthesia (including death), nerve and vascular injury about the shoulder and failure of the operation to produce the desired results. If the operation fails, it may result in stiffness or sometimes a loose joint. If the joint loosens, it may either have to be redone at a future date, or reoperated on to tighten the ligaments or muscles. With the shoulder joint, this is quite a rare occurrence, although long-term follow-ups of more than ten years are not yet available.
What is the post-operative treatment after shoulder replacement? If the shoulder was extremely tight, the doctor prefers to support the arm in a brace after surgery to allow the muscles and ligaments to heal in a lengthened position. If the shoulder was not particularly tight, then the arm can be kept in a sling at the side. Exercises begin on the day after surgery, and include movement of the elbow, wrist and hand; and exercising the grip with putty. Shortly thereafter, rotational pendulum exercises can be added. Strengthening exercises begin at about three weeks, after the brace or sling is removed. This delay is necessary to allow healing of the tissues that were opened at the time of surgery.
How long will it take for the shoulder to improve to its maximum strength? The shoulder will generally continue to improve quite steadily for up to five or six months after surgery. After that point, further improvement is very slow – although it has been shown that even after a year or more, activity can increase as muscle strength continues to improve. It is very important to continue an exercise program to regain and maintain excellent muscle strength around the new shoulder joint.
If I have any further questions, who can I call? Please feel free to call Anne Arundel Orthopaedic Surgeons, P.A., at 410-573-2530 or 1-800-331-2466 and ask for an appointment with a shoulder specialist. One of our physicians will be happy to answer your questions and evaluate your shoulder in the office.
Q & A: About Arthritis of the Shoulder