Shoulder Arthritis

Overview:

Shoulder arthritis is a condition of inflammation in one or more joints. Stiffness and pain is induced in the shoulder joint due to inflammation. The severe case of shoulder arthritis may show movement loss and grinding on shoulder motion. In diseased arthritis, damage occurs to the joint connecting the humeral head to the glenoid. People above 50 years of age are usually affected by shoulder arthritis. Prior shoulder injury or some genetic disorders enhances the risk of shoulder arthritis. Weightlifters, swimmers, baseball players, and tennis players are at high danger of this condition.

Arthritis-of-ShoulderForms:

Typically, there exists five major types of shoulder arthritis:

  • Osteoarthritis:

Osteoarthritis is the most common form of shoulder arthritis. Another name for osteoarthritis is wear-and-tear arthritis. It mainly affects the acromioclavicular joint in the shoulder. In this condition, the smooth outer cartilage of bone is destroyed. As cartilage wearing progresses, the surface becomes rough and less protective space appears between bones. Pain is induced during movement when shoulders rub against each other.

  • Rheumatoid Arthritis:

Multiple joints, throughout the body, are attacked by a chronic disease known as rheumatoid arthritis(RA). Often same joints on both side of the body are affected by this condition and hence they appear symmetrical. An outer lining called synovium covers the body joints and helps in movement. Rheumatoid arthritis induces pain, swelling and stiffness in the joint. During this condition, the immune system attacks its own tissue. So rheumatoid arthritis is characterized as an autoimmune disease. The defense mechanism of body starts to destroy soften bone and normal tissues. It is likely to appear in both acromioclavicular joint and glenohumeral joint of the shoulder.

  • Posttraumatic Arthritis:

Some type of arthritis occur after an injury. One such type is posttraumatic arthritis. It is a form of osteoarthritis. The injury includes fracture or shoulder dislocation.

  • Rotator Cuff Tear Arthropathy:

A long-term rotator cuff tendon may also cause arthritis to develop. The damaged rotator cuff is unable to support the humerus head in the glenoid socket. This damages the bone surface leading to arthritis. The combined effect of advanced arthritis and large rotator cuff tear results in excessive pain and weakness. It becomes difficult for the person to lift arm away from the side.

  • Avascular Necrosis:

Sometimes, the blood supply to the humerus head is disturbed. This leads to a chronic and painful condition called avascular necrosis(AVN). In severe condition, AVN may completely damage the shoulder joint. This is because the scarce supply of blood causes the death of bone cells. Avascular necrosis progresses in stages. With the development of AVN, the outer covering of the cartilage bone is damaged due to collapsing of dead bone cells. This results in arthritis. In initial stages, humerus head is affected but in later stages glenoid socket is completely damaged. A variety of causes such as heavy alcohol consumption, steroid overdose, sickle cell disease, and traumatic shoulder injuries. In some cases, no cause occurs. Such type is referred to as idiopathic AVN.

Symptoms:

Arthritis is mainly characterized by severe pain in the shoulder. Other symptoms of shoulder arthritis include:

  • Enhanced pain with normal activities
  • Limited movement
  • Swelling and stiffness in shoulder joint
  • Weakness around the joint
  • Catching or grinding sensation within joint

Treatments:

Treatment initially involves non-surgical procedures to treat the symptoms of shoulder arthritis. Surgery is opted as a last resort of treatment. The treatment methods are described below:

  • Non-surgical Treatment
    • Activity Modification:

Activities, such as aggressive exercises, which may hamper the movement of the shoulder should be limited. Simple shoulder exercises are appropriate for people with weak shoulders.

  • Physical Therapy:

Physical therapy exercises help to enhance the movement of shoulder. The tension on the shoulder may be reduced with strengthening and stretching exercises. These exercises tend to prevent atrophy of muscles and hence functionality of shoulder is increased.

  • Anti-Inflammatory Medications

Non-steroidal anti-inflammatory medications (NSAIDs) aim to reduce inflammation and other discomforts in shoulder. Usually these are taken along with food. These medications should be taken only after consulting a doctor. It carries some of the side-effects. These medications may induce irritation in the lining of stomach and hence result in internal bleeding.

  • Cortisone Injections

Cortisone injections are mainly useful in temporary relief of symptoms. They are effective to treat pain and inflammation caused by arthritis. However, they are not capable of providing complete cure to this condition.

  • Joint Supplements

Dietary supplement is a safe method to relief pain due to arthritis. The supplement includes chondroitin and glucosamine. Nevertheless, the effectiveness of these supplemennts to reduce symptoms is still unknown.

  • Surgical Treatment

If the condition worsens and con-surgical methods do not appear effective, then surgical procedure is opted. Different surgical methods are:

  • Shoulder Arthroscopy:

The arthroscopy technique is mainly used to treat moderate glenohumeral arthritis. In the procedure, a small incision made in the shoulder joint is used to insert an arthroscope. At one end of the arthroscope is attached a camera. It is used to display pictures of internal structures on a television monitor placed outside. These images act as guidance for small surgical instruments. The doctor usually cleans out the internal part of the joint. However, this method provides only pain relief and does not remove arthritis. If arthritis recur, then another surgery may be needed.

  • Shoulder Joint Replacement:

Joint replacement treatment essentially treats patient with advanced glenohumeral arthritis. This surgery aims to remove damaged shoulder parts. Artificial components called prosthesis is used to replace these damaged parts. The replacement surgery includes following options:

  • Hemiarthroplasty

In this method, artificial components replace only the humerus head.

  • Total Shoulder Arthroplasty

This method involves replacement of both glenoid and humerus head with prosthesis. A metal ball is connected at the upper part of humerus while a plastic cup is fitted into the glenoid.

  • Reverse Total Shoulder Arthroplasty

This process is just the reverse of total shoulder arthroplasty. In this procedure, metal ball is attached to glenoid and plastic cup is placed in the humerus head. This method is more suited for people with cuff tear arthropathy which deals with different muscles.

  • Resection Arthroplasty:

Resection arthroplasty focuses to treat people who have acromioclavicular joint arthritis. During this technique, a small incision (cut) is created on the shoulder joint. A segment of bone from the end of collarbone is collected. This bone segment is removed through this cut. This leaves a small amount of empty space in the joint. Scar tissue is used to fill this empty space.

Follow-up Care:

Surgical method is a very effective method to treat arthritis of shoulder. They provide permanent relief from severe pain and other discomforts. A proper rehabilitation program under the supervision of good therapist is beneficial. It is important to keep a balanced and soft diet for 1-2 days after surgery. Proper rest and exercises help to enhance the healing process. As a result, fast recovery is achieved.

Risks:

Similar to any treatment procedure, some risks are included in this method:

  • Excessive bleeding and blood-clots
  • Nerve or blood-vessel damage
  • Infection
  • Irregular shoulder joint

Surgical method is a very effective method to treat arthritis of shoulder. They provide permanent relief from severe pain and other discomforts. A proper rehabilitation program under the supervision of good therapist is beneficial. It is important to keep a balanced and soft diet for 1-2 days after surgery. Proper rest and exercises help to enhance the healing process. As a result, fast recovery is achieved.

 

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