Shoulder Arthritis

Osteoarthritis

Osteoarthritis is the most common type of arthritis, which increases in prevalence with age or “wear and tear”. It is a condition that destroys the articular cartilage (the smooth outer covering that protects the bone). When the cartilage wears away, the protective space between the bones decreases to the point where there is bone-on-bone contact. Movement then causes the rough bone ends in the joint to rub against each other, causing pain. With increasing severity, the knee joint will stiffen up and lose movement. Osteoarthritis usually affects people over 50 years of age.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease that can affect multiple joints throughout the body. It usually affects the same joint on both sides of the body, left and right. It is an autoimmune disease in which the body's immune system (which normally protects the body from infection) attacks healthy joints, tissues, and organs. Rheumatoid arthritis causes the joint lining (synovium) to swell and destruction of the articular cartilage, which causes pain and stiffness in the joint. It occurs most commonly in women of young to middle age (15-50 years), but can affect anyone. It mostly affects the joints of the hands and feet and tends to be symmetrical, but can also affect shoulders, hips and knees. It can lead to severe deformity in these joints.

Rotator Cuff Tear Arthropathy

After a large, chronic tear of the rotator cuff tendon, arthritis can develop in the shoulder. With the torn rotator cuff not functioning, there is nothing to hold the head of the humerus in the glenoid socket. The humerus migrates upwards untill it rubs against the underside of the acromion. This is painful and damages the cartilage, causing arthritis to develop. You may not be able to lift your arm up, due to the combination of a large rotator cuff tear and arthritis.

Post-traumatic Arthritis

Post-traumatic arthritis is a form of osteoarthritis that develops after an injury to the shoulder, such as a fracture or dislocation. It can occur months to years after the injury.

What are the Symptoms?

The most common symptom of arthritis of the shoulder is pain, which is aggravated by movement and progressively gets worse over time. Most patients complain of a deep ache in the joint. The pain may be affected by the weather. Pain is often felt at night even when not moving the shoulder and may affect your sleep.

Limited movement is the other most common symptom. Initially, patients often have difficulty with overhead activities, like hanging washing on the line or reaching a high shelf. Activities such as combing your hair or getting dressed become progressively more difficult. You may hear a grinding or clicking sound (crepitus) as you move your shoulder.

How do you make a diagnosis of shoulder arthritis?

After taking a concise and directed medical history, your shoulder will be examined.

During the examination, I will look for:

• Wasting of the muscles
• Swelling and redness
• Pain to touch or palpation
• Range of motion
• Crepitus (grinding) with movement
• Signs of previous injuries
• Involvement of other joints (an indication of rheumatoid arthritis)

Radiological imaging such as X-Rays and CT scans will give information about the bones and loss of cartilage. MRI scan may be necessary in some cases to look at the soft tissues of the shoulder, particularly the rotator cuff tendons.

Treatment options for shoulder arthritis

Non-operative Treatment

Initial treatment of arthritis of the shoulder is non-surgical. This may include the following:

• Rest or activity modification. You may need to change the way you move your arm to do certain things. You may have to stop some activities.
• Physiotherapy may improve the strength and movement in your shoulder.
• Simple pain killers, such as anti-inflammatory medications (NSAIDs) or panadol, may reduce inflammation and pain.
• Cortisone injections in the shoulder can be helpful, but the effect is often temporary.
• If you have rheumatoid arthritis, you should see a rheumatologist who may prescribe disease-modifying drugs.
• There is minimal scientific evidence to support the use dietary supplements.