Shoulder Arthritis

Background

Glenohumeral arthritis is arthritis affecting the glenohumeral joint, which is the main ball and socket joint in the shoulder. While there are many types of arthritis, the commonest is osteoarthritis (‘wear and tear’) that becomes more common with increasing age. Other types of arthritis may occur as part of a body-wide arthritis such as inflammatory arthritis (e.g. rheumatoid arthritis), or after previous injury to the shoulder (post-traumatic arthritis), or following rotator cuff failure (cuff tear arthropathy).

 

     

Causes

Arthritis is a process whereby the cartilage carpet in the joint is lost, resulting in bone rubbing directly on bone. This stimulates the body to produce more bone (osteophytes) which can stiffen the joint.

 

Symptoms

Most people report pain and stiffness as the predominant symptoms, although the shoulder may also click, crack or graunch with certain movements. While there tends to be a constant background dull ache, there can be sharper pains as well as periods of exacerbation in pain. These can sometimes follow overuse such as a heavy day of gardening. The stiffness may mean it is difficult or impossible to reach behind you to take something out of a back pocket, or make it difficult to get to the back of your hair. In some cases even cleaning your teeth may be troublesome.

 

Treatment - non-surgical

While non-surgical treatments do not affect the underling arthritis, they can control the symptoms from it. In the early stages, simply adjusting what you do and how you do it may be enough to control the pain.

Physiotherapy can be helpful in reducing stiffness and improving the muscles around the shoulder. Physiotherapy can also be helpful with posture control and to advise on different ways to perform tasks in more comfort.

You may find a steroid injection helpful. This may be given if there is uncertainty as to how much of your symptoms are coming from the glenohumeral joint and how much from elsewhere. Injections can provide relief lasting months or longer but the duration of pain relief tends to be different in different people.

 

Treatment - surgical

Arthroscopy and debridement surgery may be helpful to allow assessment of the joint surfaces, smooth any rough parts, and remove any loose bodies (fragments of bone and soft tissue) that may be floating around the joint.

Shoulder replacement surgery is the most reliable form of surgery, although also the most invasive. There are a variety of types of shoulder replacement. The one that is right for you will depend on a number of factors.

Below is a short animation of one type of shoulder replacement to give you an idea of what happens at surgery. This type may not necessarily be exactly what you would have.

 

    One example of how a shoulder replacement is performed

     

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In cases where shoulder replacement surgery is inadvisable due to the risks of surgery or the nature of your shoulder, a special injection (suprascapular nerve block / ablation) may be performed.

 

Physiotherapy / rehabilitation after surgery

You typically have a sling for 6 weeks although gentle exercises start straight away following surgery. The sling is discarded at 6 weeks and work is started on regaining you movement. Strengthening work usually starts around 3 months from surgery.

 

Outcome

Various countries in the world, including the United Kingdom, monitor joint replacements that are implanted into people to see how long they last. From this, and other information, we know that about 90% of shoulder replacements implanted are still in place at 10 years and about 80% at 20 years.

 

FAQ

Will my arthritis pain get better on its own ?

While osteoarthritis does not get better and currently we do not have a cure for it, the symptoms associated with the arthritis are much less predictable and people can find their pain settling to some extent with time, the majority however experience a progression.

 

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