Shoulder Arthritis

What is Arthritis?

In a normal joint, bone surfaces are covered with articular cartilage, an ultra-smooth structure allowing frictionless motion. Joint fluid, produced by the synovial membrane lining the joint, further aids in lubrication.

 

Arthritis, or inflammation of the joint, involves progressive injury and loss of articular cartilage, exposing bare bones. The joint loses its smooth, frictionless surface, leading to bone rubbing, friction, and inflammation.

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In the shoulder, arthritis can affect the main ball and socket joint (glenohumeral joint) and the acromioclavicular joint (ACJ). This section focuses on glenohumeral joint arthritis.

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What Are the Symptoms of Arthritis?

Pain, reduced range of motion, weakness, stiffness, and swelling are common symptoms of arthritis.

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Are All Shoulder Arthritis the Same? What Are the Causes?

No. Different types of arthritis exist, each with its underlying causes:

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a) Osteoarthritis:

Also known as primary or degenerative arthritis, this is the most common type of shoulder arthritis. It is due to the progressive “wear and tear” of the joint with usage and ageing.

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b) Rheumatoid Arthritis:

This is an autoimmune disease where your own body's defence mechanism attacks your own body cells, in this case, the synovium - the membrane lining the joints. This type of arthritis typically involves multiple joints at the same time, although the degree of involvement might be different.

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c) Post-traumatic Arthritis:

Follows previous shoulder injury like dislocation or fracture.

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d) Arthritis Secondary to Avascular Necrosis (AVN):

This is due to disruption of the blood supply (avascular) to part of a bone, commonly the humeral head, leading to a localised area of bone death (necrosis). The necrotic bone eventually collapses and causes joint damage. AVN can occur in cases of high steroid use, heavy alcohol consumption, trauma, sickle cell disease etc. Sometimes, it occurs with no underlying cause identified.

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e) Cuff Tear Arthropathy:

Linked to long-standing large rotator cuff tears. A cuff-deficient shoulder loses this inherent stability, leading to upward migration of the ball (humeral head), causing it to rub against the acromion and arthritis eventually. 

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How is Shoulder Arthritis Diagnosed?

Diagnosis can be made through symptom assessment, shoulder examination, and X-ray imaging. Further investigations like blood tests, CT scans, or MRI may be needed to evaluate the underlying cause and severity.

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What are the Treatments Available for Shoulder Arthritis?

Treatments for shoulder arthritis include pain control, physiotherapy, activity modifications, injections, and surgery.

 

The treatment algorithm is often individualized, depending on the severity of the condition and the impact of the disease on daily life. In most cases, initial treatment involves a combination of the non-operative measures mentioned above.

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Oral medications, locally applied medicated ointments/gels/patches, icing, or heat packs are some of the methods available to control arthritis pain. Steroid injections can sometimes be considered to reduce inflammation and pain. Different individuals might respond and tolerate these methods differently.

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Guided physiotherapy focuses on gentle stretching with low-impact exercises, aiming to maintain or improve range of motion, muscle tone, and strength.

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If your symptoms persist despite non-operative measures, surgery might be necessary.

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What Are the Surgical Options Available?

Depending on your age, activity level, arthritis type, and severity, your doctor may recommend one of the following operations suitable for you.

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1. Arthroscopy:

This procedure is generally recommended for patients with mild arthritis. It involves minimally invasive keyhole incisions, where the surgeon introduces a small camera (arthroscope) and instruments into the shoulder joint to inspect and debride (clean up) any loose bits of tissue, cartilage flap, and loose bodies floating and impinging within the joint. The primary goal of this procedure is to ease and relieve pain from arthritis. However, it does not reverse or eliminate arthritis or halt its progression. Patients with advanced arthritis might not be suitable for this procedure.

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