Shoulder Arthritis
What Options are Available to You?
Brent Carlson, MD
Orthopedic Surgery
Chippewa Valley Orthopedic & Sports Medicine
Eau Claire
The shoulder is often described as a ball-and-socket joint; and while the ball, or humeral head, does articulate with a socket, or glenoid, this socket is much more shallow than the socket of the hip. This shallow socket allows for more motion in the shoulder than in the hip, but makes the shoulder less inherently stable. Extra stability is given to the shoulder by the rotator cuff. Disorders occurring within the ball, the socket or the rotator cuff can lead to arthritis or degeneration of the shoulder.
Arthritis of the shoulder is characterized by destruction of the joint cartilage on the surface of the bone. There are many types of arthritis and it is important for your physician to determine which type you have in order to provide the most effective treatment.
What are the types of shoulder arthritis?
Osteoarthritis is the most common type of shoulder arthritis.
Most commonly referred to as wear-and-tear arthritis, it destroys
the articular cartilage on the surface of the bone. It is most
commonly seen in older people and tends to run in families.
Rheumatoid arthritis is an autoimmune disorder wherein a
patient’s own white blood cells attack the joint. It often affects
both shoulders and can be seen in people of any age.
Osteonecrosis is a term describing death of the bone beneath the cartilage surface of the humeral head. It leads to a ball with an irregular surface as the soft dead bone collapses. Causes include steroids, alcohol abuse, lupus and other unknown factors.
Post-traumatic arthritis occurs after a fracture of the bone, a dislocation or direct injury to the cartilage surface of the joint.
Rotator cuff tear arthropathy develops from long-standing, untreated rotator cuff tears which cause the shoulder to become unstable. Without an intact rotator cuff, the ball cannot easily remain centered in the socket and arthritis frequently develops.
What are the symptoms of shoulder arthritis?
The most common symptom is deep-seated pain often localized to the back of the shoulder, but pain can be present anteriorly as well. Early in arthritis pain is worse with strenuous activities, but with time, any motion of the shoulder can cause pain. Shoulder motion becomes limited with overhead activities. Eventually, combing the hair or dressing becomes challenging. Pain at night is common and sleeping becomes difficult.
How is shoulder arthritis diagnosed?
A physical exam and x-rays are needed to diagnose arthritis and determine the type of arthritis present. Creaking and snapping within the joint while rotating the shoulder may be present. Weakness within the shoulder muscles is often apparent on examination. Shoulder range of motion is usually decreased.
X-rays will show narrowing of the joint space in all types of arthritis. Osteoarthritis will show bone spurs, but rheumatoid arthritis will often show bone cysts and a notable lack of bone spurs. Osteonecrosis will demonstrate soft, less dense bone in a portion of the humeral head. A ball riding high on the socket is seen in rotator cuff tear arthropathy.
What nonsurgical treatment options are available?
As in other types of arthritis, nonsurgical treatment is recommended initially. Anti-inflammatory medication such as ibuprofen or acetaminophen can decrease the inflammation in the shoulder, as can ice applied before and after activity. Anti-rheumatic drugs such as methotrexate may be prescribed for rheumatoid arthritis. Modifying the way you perform your activities at work or around home may help. A steroid injection may provide relief for some time, especially in cases of rheumatoid arthritis.
What surgical options are available?
When nonsurgical treatment does not adequately treat the pain with shoulder arthritis, shoulder replacement offers a very satisfactory solution. The shoulder can be treated by replacing both the ball and socket in a total shoulder arthroplasty or by replacing only the ball in a hemiarthroplasty.
Young patients with osteonecrosis may benefit greater from a hemiarthroplasty. Patients with end-stage rheumatoid arthritis and with fewer demands on their shoulders generally do very well with a total shoulder arthroplasty. Patients with chronic rotator cuff tears need special consideration and often benefit from a specialized type of hemiarthroplasty or a reverse total shoulder arthroplasty. A reverse shoulder arthroplasty places a ball where the socket normally resides and a socket onto the humerus. The reverse arthroplasty is best reserved for older patients with chronic rotator cuff tears in need of increased shoulder motion.
Regardless of the severity of arthritis you may have, consider being evaluated by an orthopaedic surgeon. Your surgeon will be able to develop an individualized treatment plan and discuss whether you are a candidate for a shoulder replacement.
Dr. Carlson — Chippewa Valley Orthopedics & Sports Medicine
For information or to schedule an appointment:
715.832.1400 | www.cvosm.com
Dr. Carlson sees patients in Eau Claire, Chippewa Falls, Neillsville and Rice Lake.
