What is shoulder arthritis?

Shoulder arthritis is deterioration of the cartilage surrounding the joints of the shoulder. These joints include:

  • the ball and socket joint of the shoulder, also called the glenohumeral joint
  • the acromioclavicular joint, where the collarbone joins with the shoulder blade

While the scapulothoracic joint—the place where the shoulder blade interacts with the chest cavity—is also considered a joint of the shoulder, it does not develop arthritis.

The acromioclavicular joint commonly has arthritis but rarely requires treatment. The term shoulder arthritis generally refers to arthritis of the glenohumeral joint (ball and socket).

Causes

The most common form of symptomatic arthritis of the shoulder is osteoarthritis. Osteoarthritis is a condition that affects over 60 million Americans. Osteoarthritis can affect almost any joint in the body. It is a condition in which the cartilage covering of the bone ages and deteriorates. It sometimes results in stiffness and pain of the involved joint. The causes of osteoarthritis vary. It can result from injury, but most patients with osteoarthritis have it as a result of their genetic makeup. It can also be a side effect of certain drugs and environmental influences.

Shoulder Arthritis - Labrum , degenerative tearingRheumatoid arthritis is a fairly common cause of shoulder arthritis. Most people that have arthritis of their shoulder due to rheumatoid disease already carry a diagnosis of rheumatoid arthritis.

Lupus can cause shoulder arthritis. Gout can lead to shoulder arthritis. There is a form of arthritis called psoriatic arthritis that can affect the shoulder.

Lastly, infection of the shoulder joint can lead to arthritis.

Symptoms

Shoulder Arthritis _Bare bone_ humeral head. All articular cartilage is gone, leaving only boneArthritis of the shoulder is usually manifested as pain or stiffness of the shoulder. The pain is generally noted in the proximal humerus area. It is a deep pain. Patients have a hard time “putting a finger on it”. Most patients find that their pain increases if they use their shoulder for activities that involve extreme movement of the shoulder and/or where heavy loads are placed upon the shoulder. A lot of patients have difficulty sleeping when their shoulder arthritis is painful.

Diagnosis

A shoulder practitioner can usually diagnose shoulder arthritis with a combination of careful history, physical examination, and sometimes imaging studies. In most cases, a plain x-ray is sufficient imaging to establish the diagnosis.

Treatment

The following are sometimes appropriate for treatment of osteoarthritis:

Physical therapy

It’s not clear exactly why, but physical therapy works very well for osteoarthritis of the shoulder. Physical therapy is generally oriented towards goals of increasing strength of the muscles that operate the shoulder and stretching the ligaments of the shoulder by utilizing a home exercise regimen. Most patients will notice a benefit from therapy after a month or two of trial.

Activity modification

Sometimes simple activity modifications will lessen the pain and shoulder arthritis enough that that’s all the patient needs. For example, heavy loads on the shoulder will tend to aggravate shoulder pain due to arthritis. If the patient has the ability to lessen the loads on the shoulder, that simple step may lessen his or her pain to a satisfactory level.

Home exercises

Home exercises have the same goal as supervised physical therapy. They are intended to strengthen the shoulder girdle muscles and stretch the ligaments of the shoulder.

Medication

Anti-inflammatory medication taken by mouth will sometimes lessen the pain and stiffness of arthritis of the shoulder.

Injection of cortisone medication into the shoulder joint is also a very effective way to control the pain and stiffness of arthritis of the shoulder.

Cortisone Injection FAQs

Surgery

There are many types of surgery that can be performed for arthritis of the shoulder. In most cases, surgery is for shoulder replacement. There are some situations of mild to moderate arthritis that can be improved with arthroscopic surgery.

Treatment of arthritis in the shoulder is designed and intended to improve the symptoms of arthritis. It is designed to lessen the pain and lessen the stiffness of the involved shoulder joint. Most treatments do not alter the natural history of the arthritis. If a patient has osteoarthritis of the shoulder that shoulder will become more arthritic as they age no matter what treatment is rendered. A cure for arthritis of the shoulder remains unknown.

Learn More About Shoulder Replacement Here
Learn More About Shoulder Hemiarthroplasty Here

Arthroscopic Chondroplasty FAQs

What surgery are you suggesting?

I am suggesting that we operate on your shoulder to stimulate tissue formation on the ball and socket of the shoulder joint.

Is it done in an operating room?

Yes.

Will I be anesthetized?

This is usually done under a general anesthetic. The surgery can also be done with just the shoulder anesthetized. That method involves numbing nerves to the shoulder. It is called an interscalene block. It is common to be sedated if the surgery is done with an interscalene block. The sedation is such that most patients will take a nap during the procedure. You and your anesthesia professional will decide which anesthetic is best for you.

Do I have to stay in the hospital?

No. This is an outpatient procedure in most cases.

What are the alternatives to surgery?

This surgery is done to improve function and decrease pain. If a patient finds that their pain and function are acceptable, it is reasonable to decline surgery.

What is arthroscopic chondroplasty?

It is a way of stimulating the growth of tissue on the surface of the ball or socket. When successful, this tissue helps relieve the pain of arthritis. We think it does this by substituting for cartilage in an area where the cartilage has worn away due to arthritis. Typically, a wound is made on the posterior aspect of the shoulder and another on the front part of the shoulder. Each of these is about ⅜ inches long. Through these incisions, one can enter the shoulder joint and perform the surgery.

About Your Doctor

How many of these have you done?

I do not have an exact total. I have been performing surgery since 1981. I do operations on the shoulder at a rate in excess of 250 per year. I am a Board Certified Orthopaedic Surgeon. I have been in practice at Piedmont Orthopaedics since 1986. I subspecialize in my practice, and most of what I take care of relates to problems of the shoulder.

Risks

What are some of the things that could go wrong?

The anesthesia carries risks with it. The person who evaluates you for your anesthetic will discuss those risks with you. In general, complications from anesthesia are very, very rare, but they do exist.

How often does an infection occur?

Approximately 1% of shoulder surgeries become infected soon after surgery.

What happens if there is an infection?

Infection will sometimes require that another operation be done on the shoulder. During that surgery the infection is washed out and intravenous antibiotics are often begun. Intravenous antibiotics may be necessary for 6 weeks, and long-term oral antibiotics may be necessary.

Will my shoulder get stiff?

It takes about 6 months to gain maximal flexibility of the shoulder after this operation. Some patients will take as long as a year to gain that maximum flexibility. About one in 30 patients will develop a “frozen shoulder” after this surgery. They generally experience about four weeks of significant stiffness that dramatically slows their progress. It will resolve with exercise and time.

Could I die?

No surgery is absolutely safe. It is possible that one could die from any type of operation. The death rate from this operation is profoundly low. I would estimate that it is less than 1 in 10,000. Other major events such as heart attack or stroke are extremely rare following this type of surgery.

Will I need a blood transfusion?

Almost certainly, no.

Will it relieve my pain satisfactorily?

I find that about 40% of patients with arthroscopic chondroplasty are happy with their result. Another 20% or so are happy with reservations. As an example of what that means, a patient says their shoulder feels much better and performs better, but they still have some aching. Approximately 40% of patients feel as if the shoulder surgery was not beneficial to them.

Will I have limitations on what I can do after it is healed?

No. It is safe to pursue all activities without restriction once completely healed.

A Common Sequence of Recovery

What is involved in this type of surgery?

In preparation of surgery, you will be asked to not eat or drink for at least 8 hours prior to surgery. Specific times to stop all food and drink will be given to you by your anesthesia professional. If you are on a drug that causes blood thinning such as Plavix or Coumadin, be sure to mention that to me. It may be important that those drugs be stopped well in advance of surgery. If you have rheumatoid arthritis or lupus and are on certain drugs for those conditions, they too may need to be stopped prior to surgery.
The anesthesia personnel who evaluate you for surgery will determine what lab work, if any, is needed. On the day of your surgery, you will be asked to arrive well in advance of the surgical time. After surgery is over, you will need to remain at the facility for at least 1 hour. It is okay to eat or drink as soon as you feel like it after surgery. Your pain can be controlled by using the pain medication pills that I will prescribe for you. Pills will not eliminate all of the pain, but they will make it tolerable. Pain may be severe in the first few days. Pain can also be helped by the use of ice on the shoulder, sitting in an upright position as in a recliner and resting the arm in a position of maximal comfort to the side. Within the first 2 weeks of surgery, I usually recommend beginning some exercises to the shoulder. I will either instruct you in how to do these or I will ask a therapist to do so.

What about the overall recovery from this operation? How long does it take to reach maximum improvement?

Approximately 6 months is common.

Will I be hurting that long?

No. Generally, within a week or two a person notices some diminution in their pain. They continue to gradually improve over several months.

How long will I need prescription pain medication?

This varies widely. There are occasional patients who will use only a day or two of prescription pain medication. Much more commonly, I see patients using narcotic analgesics until about one week following surgery. One of the last discomforts to go away is nighttime pain, and many patients will still use a pain pill to help them sleep for as long as 3 weeks after surgery.

When are the sutures removed?

I use surgical glue. No sutures or staples require removal.

When can I get it wet?

The surgical glue is waterproof, so it is okay to take a bath or a shower from the very first day.

Will I have to wear a sling?

Yes. A sling is provided at the time of surgery and the patient is instructed to use it until comfortable without it. Some patients will give it up in a day, while others will use it for a week or more. If you are resting comfortably in a chair at home, it is fine for the sling to be off.

Is any special wound care required?

The scar will look prettier sooner if you rub vitamin E or cocoa butter into it.