SHOULDER ARTHRITIS

OVERVIEW

The shoulder consists of two joints. The larger glenohumeral joint is a ball and socket type joint formed by the glenoid (socket) and head of the humerus (ball). The second smaller joint in the shoulder is the acromioclavicular or AC joint formed between the clavicle (collar bone) and scapular bone (shoulder blade). In shoulder joint arthritis the cartilage covering these bones inside the joint is damaged. Shoulder arthritis mostly refers to the glenohumeral joint. However, arthritis can also develop in AC joint.

Causes

There are several different causes of shoulder arthritis.

1. Osteoarthritis (a degenerative joint disease caused by wear & tear due to aging)
2. Rheumatoid arthritis (an autoimmune disease which means own immune system attacks the lining of the joint)
3. Injury (fracture, dislocation, or other injuries)
4. Long-standing massive rotator cuff tear
5. Avascular necrosis of humeral head (blood supply to the humeral head is disrupted causing bony collapse and arthritis)

Diagnosis

1. Patients present with pain, stiffness, grinding, clicking or crackling (crepitus) and restriction of joint motion in the shoulder joint.
2. The patient is advised to undergo few X rays of the shoulder
3. Some patients may need higher investigations like CT scan and MRI scan

Treatment and prevention

The initial treatment for shoulder arthritis is usually medical (nonoperative) treatment which includes following

1. Physiotherapy and exercises: The patient is advised physiotherapy to improve or maintain the range of motion, achieve muscle balance, decrease pain and decrease inflammation/swelling.
2. Lifestyle Modifications: Arthritis cause permanent damage therefore it is important to adopt a lifestyle that makes it less painful. Generally, anything that causes pain should be avoided
3. Pain Control: Ice packs can reduce acute inflammation and pain. Some people may feel better with hot fomentation. You should use whatever strategy provides the best relief. Your doctor may also prescribe you pain killer medicines to control pain. These drugs include acetaminophen, NSAIDs and other analgesics.
4. Joint supplements: Newer drugs containing collagen and other supplements can help.
5. Injections in the Shoulder can also provide you temporary relief. There are two types of injections that can are used viz. Corticosteroid and Hyaluronic acid.

Corticosteroid provides immediate pain relief as it has anti-inflammatory action.

Hyaluronic acid is a naturally occurring lubricant in the joint. It provides a long-lasting effect and can be repeated multiple times without adverse effects.

Surgical treatment

When conservative treatments fail to provide relief, you may be advised of surgery. Surgical options depend on your age and the degree of arthritis.

1.   Arthroscopic Shoulder Debridement: It is a minimally invasive procedure in which the joint is cleaned with the use of a small telescope (arthroscope) and surgical tools inserted through small incisions into the shoulder joint. It is recommended for patients with early arthritis. This operation is not a permanent solution as it does not change the presence of the disease however it can relieve pain for 12 to 24 months.

2.   Shoulder Replacement: This procedure replaces the ball and the socket parts of the shoulder joint with artificial parts. Shoulder replacement is preferred in advanced shoulder arthritis. It relieves the pain of arthritis, and it has been shown to last for many years. It is of 3 types. When the glenoid is replaced with a socket and humeral head with the ball it is standard of anatomic total shoulder replacement. When the glenoid is replaced with a ball and the head is replaced with a socket it is reverse total shoulder replacement. When only a part of the joint is replaced it is called hemi shoulder replacement.