Shoulder Arthritis

The Bone and Joints

of the shoulder

Anatomy

Your shoulder is comprised of three bones:

• Upper arm bone (humerus)
• Shoulder blade (scapula)
• Collarbone (clavicle)

The glenoid is a rounded socket in your shoulder blade that the head of your upper arm bone fits into. The rotator cuff is a combination of muscles and tendons that keep your humerus centered in your shoulder socket.

The two joints in your shoulder are called the acromioclavicular joint and the glenohumeral joint. Either or both may be affected by arthritis. The acromioclavicular joint is located where the collarbone meets the tip of the shoulder blade (acromion). The glenohumeral joint is located where the head of the humerus fits into your scapula.

Condition

Shoulder arthritis can make daily activities like brushing your hair or reaching a high shelf challenging. The pain is result of bones of the joint rubbing against each other during movement.

• Osteoarthritis – is also known as wear-and-tear arthritis. Daily wear and tear can destroy the articular cartilage and decrease the protective space between the bone; therefore, osteoarthritis is often referred to as “bone on bone” arthritis. It usually affects patients over the age of 50 and more commonly identified in the acromioclavicular joint than in the glenohumeral joint.
• Rheumatoid Arthritis (RA) – is a chronic, autoimmune disease that affects multiple joints throughout one’s body. RA is symmetrical, which means that it usually affects the same joint on both sides of one’s body. It is common in RA patients that both joints of the shoulder are affected. Synovium is a lubricant lining that covers the joints of our body and makes it easier to move. RA causes the lining to swell, making joints stiff and causing pain.
• Posttraumatic Arthritis – is a form of osteoarthritis that develops after a traumatic injury to the shoulder like a fracture or dislocation of the shoulder.
• Rotator Cuff Tear Arthropathy – is a result of a large, long-standing rotator cuff tendon tear. The torn rotator cuff is no longer able to hold the head of the humerus in the glenoid socket. Arthritis develops because the humerus then moves upward and rubs directly against the acromion causing damage to the surfaces of the bones. The combination of a large rotator cuff tear and advanced arthritis can be very painful and significantly reduce mobility of the entire arm.
• Avascular Necrosis (AVN) – occurs when the blood supply to the head of the humerus is disrupted. Bone cells need blood supply. If AVN is left untreated, it can ultimately lead to destruction of the shoulder joint and arthritis. AVN is a painful condition that develops in stages. In the beginning, AVN affects only the head of the humerus. As it progresses, the dead bone gradually collapses, damaging the glenoid socket and the articular cartilage leading to arthritis. The causes of AVN are somewhat ambiguous. Research has shown high dose steroid use, heavy alcohol consumption, sickle cell disease, and traumatic injury can all contribute to AVN.

Symptoms

There are three major symptoms of shoulder arthritis:

1. Pain – is the most common symptom. Pain is aggravated by movement, weather, and gets worse over time. As the disease progresses, any movement of the shoulder causes pain with night pain and sleep disruption being major complaints. The location of the pain varies depending on the joint affected. If the glenohumeral shoulder joint is affected, the pain is centered in the side or back of the shoulder and feels like a deep ache in the joint. If the acromioclavicular joint is affected, the pain is centered on the top of the shoulder and can travel to the side of the neck. RA patients may experience pain throughout the shoulder if both shoulder joints are affected.
2. Limited range of motion – is a symptom that affects daily activities due to the limitation of motion in the arm.
3. Crepitus – is a snapping sound (grinding, clicking) that is heard when moving the shoulder. It can be painful and audible to others around you.

Treatment

Dr. Stowell will discuss your symptoms and medical history. He will examine your shoulder and look for weakness in the muscles, tenderness, mobility, crepitus, pain triggers, and may order X-rays to see a more detailed picture of your shoulder. X-rays of an arthritic shoulder will show a narrowed joint space, changes in bone structure, and bone spurs (osteophytes).

Initial treatment of shoulder arthritis is nonsurgical. Dr. Stowell may recommend:

• Rest or change in daily activity to prevent provoking pain.
• Physical therapy to improve range of motion and strength in your shoulder.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen to reduce inflammation and pain.
• Corticosteroid injections in the shoulder to dramatically reduce inflammation and pain, temporarily.
• Moist heat application for temporary pain relief.
• Icing your shoulder for 20 to 30 minutes, two or three times a day to reduce inflammation and pain.
• For RA patients, special prescription medication.

Surgical treatment may be recommended by Dr. Stowell if your pain causes disability or is not relieved by nonsurgical treatments. There are multiple surgical methods that Dr. Stowell may use to treat your condition:

• Arthroscopy – treats mild glenohumeral arthritis. During arthroscopy, a small camera called an arthroscope is inserted into your shoulder joint. The camera displays pictures on a video monitor, which Dr. Stowell then uses to help guide his surgical instruments. Smaller incisions are made because the arthroscope and surgical instruments that Dr. Stowell uses are thin. Dr. Stowell may also debride or clean out the inside of your joint during the procedure. It will provide pain relief, but will not eliminate the arthritis from the joint. Future surgery may be considered if the arthritis progresses.
• Shoulder joint replacement (arthroplasty) – treats advanced arthritis of the glenohumeral joint. In this procedure, Dr. Stowell removes damaged parts of the shoulder and replaces it with artificial components called a prosthesis. Shoulder replacement surgery options include:
  1. Hemiarthroplasty – the head of the humerus is replaced with a prosthesis.
  2. Total shoulder arthroplasty – the head of the humerus and the glenoid are replaced. A plastic cup is fitted into the glenoid and a metal ball is attached to the top of the humerus.
  3. Reverse total shoulder arthroplasty – is the exact opposite of a total shoulder arthroplasty procedure where the metal ball is fixed to the glenoid and the plastic cup is fixed to the upper end of the humerus. A reverse total shoulder arthroplasty does not rely on the rotator cuff to move the arm, but rather different muscles that work better for people with cuff tear arthropathy.
  4. Resection arthroplasty – is the most common surgical procedure used to treat arthritis of the acromioclavicular joint. Dr. Stowell removes a small amount of bone from the end of your collarbone, leaving a space that gradually fills in with scar tissue.

Recovery from surgery of arthritis of the shoulder is generally very effective in reducing pain and restoring motion. Length of recovery time and rehabilitation depend upon the type of surgery that Dr. Stowell performed as well as your unique comorbidities (other medical conditions) and health factors. You will feel some pain after surgery, which is a normal part of the healing process. Dr. Stowell will discuss options with you about ways to reduce your pain and recover from surgery quickly.

Complications from surgery, as with all surgeries, exist. Potential issues include infection, excessive bleeding, blod clots, and damage to blood vessels or nerves. Dr. Stowell will discuss with you the possible implications before your surgery.

Dr. Stowell is at the forefront of orthopedic advancements in treating shoulder arthritis. Much research is currently being done on shoulder joint replacement surgery, including development in joint prosthesis designs. Researchers continue to study the use of biological materials like tissue grafts to resurface an arthritic shoulder. As further developments are made, Dr. Stowell will discuss available options with you to provide you with an optimal treatment plan.