Arthritis is a common condition which can affect any joint. There are two parts of the shoulder which can be affected by arthritis. The gleno-humeral (ball and socket) joint is the main joint and the second is the acromioclavicular joint and is where the top of your shoulder blade meets your collarbone.
Arthritis actually means “joint inflammation” and there are two main types:
This is the “wear and tear” or degenerative type of arthritis and can be primary or secondary. Primary osteoarthritis means there has been no particular cause and secondary osteoarthritis occurs following an injury or infection.
The cartilage which normally covers the joint surfaces, and provides a smooth gliding surface, becomes thinner and spurs of extra bones, which are termed osteophytes, may form. Osteophytes can alter the shape of the joint and make it stiff. Eventually the bones start to rub together leading to pain.
The most well-known type of inflammatory arthritis is rheumatoid arthritis but most other types of inflammatory arthritis may affect the joint in a similar way. The shoulder joint is covered with a lining (synovium) responsible for producing the lubricating joint fluid. Rheumatoid arthritis causes the lining to swell, causing pain and stiffness in the joint. In Rheumatoid arthritis some of the defences that normally protect the body from infection instead damage normal tissue and soften bone. These give slightly different appearances on an X-ray to those seen with osteoarthritis. Sometimes, however, osteoarthritis can then also occur secondarily to an inflammatory arthritis, in which case a mixed picture will be seen on X-ray.
Symptoms of Arthritis
The cardinal symptoms are pain and stiffness, often with creaking and grating arising from the joint with attempted movement. The symptoms usually come on relatively slowly and gradually worsen, but may fluctuate to a degree on a day to day basis. There may be only a dull background ache with the worst pain coming on at the extremes of movement.
Treatment of Arthritis
Simple painkillers and anti-inflammatory medications can be helpful, particularly in the early stages of arthritis. Physiotherapy can be beneficial to promote movement within the joint, maintain and build strength and function as well as help to control pain. At Yorkshire Shoulder Physiotherapy we will develop a program of strengthening and stretches tailored to your individual needs. Manual therapy, including joint mobilisations and soft tissue massage, may also be beneficial for this condition.
Injections are often used in the management of shoulder arthritis. At Yorkshire Shoulder Physiotherapy we offer both steroid and Ostenil injections to help control pain. If these measures do not work, or become ineffective with time, surgery may be considered and we can refer you to an experienced orthopedic surgeon. Occasionally surgery may be indicated in the form of arthroscopy (keyhole surgery) or joint replacement.
Shoulder Joint Replacement
There are several options when it comes to shoulder replacement. The first involves replacing the ball side of the joint alone a procedure termed hemiarthroplasty, or ‘half shoulder replacement’. The second involves replacing both sides of the joint a procedure termed a total shoulder replacement. Total shoulder replacements can either be anatomic in nature, whereby the ball and socket are swapped for a new ball and socket. The second option is what is termed a reverse shoulder replacement.
Rotator Cuff Arthropathy
This is a type of degenerative shoulder arthritis which arises as a result of a longstanding tear of the rotator cuff. When the rotator cuff fails to work, its stabilising effect which normally keeps the ball centered in the socket is lost. This means that the remaining intact muscles no longer produce a smooth rotation of the humeral head, but instead lead to a shearing movement of the ball on the socket. This results in wearing of the joint. This effect usually happens over years and this condition tends to occur in the older population.
A patient with rotator cuff arthropathy usually has a long history of shoulder problems. They often have history of shoulder pain felt predominantly on the outside of the upper arm and may have had difficulty lifting the arm up from the side. As the arthritis develops, the shoulder may become increasingly stiff and painful.
Initial treatment may involve the administration of a steroid injection to reduce discomfort, along with specialised physiotherapy to try and improve movement. This type of physiotherapy is known as an anterior deltoid strengthening program. The idea is to strengthen the deltoid to take over some of the work of the torn rotator cuff and to restore the balance between the remaining muscles around the shoulder. If this approach fails to provide adequate symptomatic improvement, a suprascapular nerve block may be considered, particularly if surgery is not appropriate. Administration of a suprascapular nerve block does not preclude progression to any other the of the other existing treatment options.
Open surgery for rotator cuff arthropathy is more significant and involves a special type of joint replacement known as a reverse total shoulder replacement. This type of shoulder replacement basically involves using a replacement which reverses the orientation of the ball and socket in the shoulder. This makes the remaining muscles much more efficient. This usually results in improved range of movement as well as less pain. There are other options which may be more appropriate for the younger patient suffering with rotator cuff arthropathy. After this type of surgery the arm is usually kept in a sling for about four weeks but gentle physiotherapy will begin in the first week.