What is shoulder arthritis?
Arthritis describes the loss of the smooth cartilage surface on the surface of the bones in a joint. In the shoulder this means that the cartilage can be deficient on the ball side (humerus) or socket side (glenoid) or both.
Why does it happen?
There are two main types of arthritis. These are
Osteoarthritis – this is the wear and tear arthritis. This may be due to genetics (it runs in the family), previous trauma such as dislocations, overuse or less commonly infection.
Inflammatory Arthritis – this includes types of arthritis such as rheumatoid arthritis. In these situations, there is inflammation
What are the symptoms and signs?
Pain is the most common feature. This is often worse with movement and improves with rest. It is not uncommon to experience a continuous aching discomfort which can affect your sleep.
Stiffness or a loss of movement is another hallmark of arthritis. It may be more difficult to perform overhead activities or to twist/rotate the arm to the side. Sometimes crunching or grinding noises can be heard and felt in the shoulder
How do you diagnose Shoulder Arthritis?
This can almost always be diagnosed from an X-ray of the shoulder. This will be peformed in the clinic if arthritis is suspected. In some situations, it is necessary to undertake CT or MRI scans where the diagnosis is less clear with normal x-rays.
Will it get better on its own?
The symptoms can be improved by various treatments but the underlying joint damage cannot be reversed.
What treatments are available?
Physiotherapy – it is essential to keep the shoulder muscles balanced and in optimal working order. Often, a course of physiotherapy can be hugely beneficial. In situations where surgery is planned, undertaking physiotherapy prior to any procedure can speed up the recovery process.
Pain killers – these are an excellent way to reduce your symptoms during the painful episodes. Paracetamol and anti-inflammatory medications are the best first line and your doctor or pharmacist will be able to advise which are safe for you to take.
Injections – steroid injections can be of benefit in cases of early arthritis but this should be discussed in detail. Visco-supplementation injections are occasionally used in younger patients with wear and tear arthritis (osteoarthritis )where pain continues to be a problem but it is desirable to defer any surgery.
Key hole Surgery – this can be used in selected cases to release tightness within the joint and to clean out any loose fragments of bone or cartilage. Whilst this does not cure the arthritis, it can serve to improve symptoms and delay more invasive major procedures.
Shoulder Replacement – this is the final option and entails replacing both sides of the worn joint (ball and socket) with new metal and plastic surfaces. This is a well established procedure 90-95% good to excellent results.
What does a shoulder replacement entail?
This requires a surgical incision at the front of the shoulder. The worn joint surfaces are removed and new metal and plastic joint surfaces are secured in place. These are similar to the materials used in hip and knee replacements. It is most commonly performed under general anaesthesia (being asleep) and supplemented with an injection to help with post operative pain (brachial plexus block).
What are the complications?
Complications are uncommon but those specific to the shoulder replacement itself can include infection, loosening, stiffness, dislocation, persistent pain and late failure of the rotator cuff.
What rehabilitation is necessary?
It is necessary to stay in hospital for one to two nights after the procedure. Physiotherapy is commenced immediately and further physiotherapy is undertaken in the outpatient setting. A sling is used for four to six weeks to protect the tissues in the shoulder whilst they are healing. Driving can be re-introduced at around the eight week mark post-operatively subject to assessment by the the operating surgeon and physiotherapists.
How log do the shoulder replacements last?
We believe that 90% of shoulder replacements are functioning well at ten years post surgery and 80% still functioning without the need for revision procedure at 20 years.