Guide to Arthritis
Bone and Joint Problems
Shoulder arthritis typically affects both men and women over the age of 50. It is more common in patients with previous shoulder injuries. There is also some evidence to suggest that people can be genetically predisposed to developing it as the condition tends to run in families. There are two joints in the shoulder: One located at the juncture of the collarbone (clavicle) and shoulder blade tip (acromion) which is called the acromioclavicular or AC joint. The other is located at the juncture of the humerus (upper arm bone) and the shoulder blade (scapula) and is called the scapulothoracic or glenohumeral joint. A doctor will need to determine which joint is affected and what type of arthritis is causing the symptoms before determining treatment.
What Are The Symptoms?
The symptoms will depend on which type of arthritis is causing the problem. There are 3 main types:
This condition causes the joints to become inflamed and tender. Pain in the shoulder may start in the morning and last for an hour. If rested too long the joints can become stiff and red. Gradually over time the shoulder will lose its range of motion and may become permanently swollen. Rheumatoid arthritis can start at any age but 75 percent of cases are reported in women. It typically affects the hands, shoulders and knees, and less commonly the elbows, hips (see hip arthritis) and neck. Most people are affected in more than one joint, so both shoulders may suffer.
Osteoarthritis is a degenerative condition which comes from wear and tear. It happens when cartilage, the protective covers over the end of bones in the joint become damaged, thin and brittle. As it deteriorates the bone underneath becomes thicker and spreads out (osteophytes - see symptoms of arthritis). The bones, which are no longer adequately separated, rub together causing pain. The condition tends to develop gradually over many years and affects different parts of the body. Although it is associated with aging, researchers are trying to identify what factors can trigger the degeneration process. When it occurs in the shoulder it is more common in the acromioclavicular joint than in the glenohumeral joint. Osteoarthritis of the shoulder can cause a sharp, burning and constant pain. You may feel stiff and creaky in the morning and the joint can make cracking sounds. As the condition progresses movement in the affected shoulder can become restricted.
This is a form of osteoarthritis that develops after an injury, such as a dislocation or fracture of the shoulder. Although normal physical activity is good for the bones, very hard or repetitive activities can injure the joints and lead to arthritis in later years. This is a particular concern for people who play contact sports such as American football and rugby. Injury can also cause a tear to the rotator cuff, an important group of muscles which allow full motion of the arm. It is a frequent injury sustained by athletes who use repetitive swinging motions such as swimmers, tennis players and water polo players. Exercising too soon after an injury is one of the causes of arthritis and can lead to osteoarthritis of the joint later in life.
How Is It Diagnosed?
Arthritis Diagnosis: A physical examination and X-Ray of the shoulder will be needed to diagnose the problem.
The doctor will begin by taking a medical history, asking the patient to describe the symptoms. They will ask how you feel, to describe the pain, stiffness and any limitations in joint movement. They will want to know if symptoms have progressed and if they are better or worse at any time of the day. Finally you will be asked about any other existing medical conditions and/or medications you may be taking.
The doctor will examine the joints, muscles and nerves around the shoulder. He will be looking for signs of:
• Bony swellings, indicating osteoarthritis.
• Joint tenderness.
• Restriction of movement.
• Thinning or weakening (atrophy) of muscles.
• Excess fluid or instability in the joints.
• Pain when pressure is applied to the joints.
• Signs of previous injuries.
• Crepitus, a popping sound that occurs when joints rub together.
There is no blood test which can categorically diagnose the 3 main types of arthritis which affect the shoulder, but you may still be given one to rule out other types such as infectious arthritis. An X-ray is the most useful test as it can show how much damage has occurred. Any narrowing of the joint space and changes in the bone shape (formation of osteophytes) can be identified. The limitation of X-ray is that it cannot predict how much pain or disability the patient will suffer. It may also miss signs of early osteoarthritis. An MRI scan is more accurate, but also more expensive.
What Is The Treatment?
Arthritis Treatment: The goal of treatment is to reduce inflammation, pain and stiffness and to help the patient return, as far as possible, to an active life. Mild to moderate cases of arthritis in the shoulder can be managed successfully with over the counter painkillers (non-steroidal anti-inflammatory drugs, NSAIDs) like ibuprofen, aspirin and paracetomal. If these are not strong enough, prescription NSAIDs may be prescribed containing codeine. If rheumatoid arthritis is diagnosed as the cause of shoulder pain, disease modifying and immuno-suppressive drugs (DMARDs) may be prescribed.
Cortisone injections, injected directly into the joint can help reduce inflammation and pain. While this is not a cure, it can reduce symptoms for several weeks or even months. It is only prescribed where rheumatoid arthritis is diagnosed as the cause of shoulder pain. As cortisone is a steroid it should be taken with caution, high doses can cause weight gain, diabetes and osteoporosis in women.
Strengthening exercises are particularly beneficial because they help to strengthen the muscles which move and protect the joints. Many people are afraid to exercise an arthritic joint for fear of causing further damage, but this only leads to muscle wastage and further joint weakness. Start any new exercise program slowly and do more as you become stronger. The easiest exercises for the shoulder are called pendulum exercises. They are performed by bending forward to allow your arm to hang down towards the ground. Make small circles with your hands which allow the momentum to carry the arms around effortlessly. Before starting any new program, discuss it with a doctor or physiotherapist first. See also, Natural treatment for arthritis as well as books on arthritis for exercise programs.
If you have access to a hydrotherapy pool use it once or twice a week. The warm water helps to relieve stiffness and promotes better blood circulation. Typically the water is warmed to 34 C/93 F.
Massage is ideal for loosening shoulder joint muscles. It can ease tension, increase blood and lymph flow and improve muscle tone. If you are on a budget, ask your therapist to restrict the session to the back and shoulders rather than a full body massage. Or if you have a partner willing to help, so much the better.
If pain is persistent and chronic and is not responding to non-surgical treatment, then surgery may be a consideration.
Arthroplasty is surgical procedure which is carried out to reconstruct or replace a diseased joint. It will help restore function in the joint and correct any deformities which have occurred. Part or the entire joint can be replaced with a plastic or metal prosthesis. Arthroplasty will not halt the disease but it usually provides pain relief and improved function in the joint most affected. It is only usually considered where more conservative treatments like steroid injections, physical therapy and exercise have failed to bring about enough pain relief or mobility to resume everyday activities. It is an elective surgery, which means it never 'required'. It is carried out by an orthopedic surgeon. If you are considering the procedure, it is worth locating a surgeon who specializes in shoulder surgery specifically as most general orthopedics only perform one or two shoulder surgeries a year.
How Long Will The Replacement In The Shoulder Last?
In one study (Torchia and colleagues) researchers reported that 93 percent of patients still have their prosthesis in place 10 years later and 87 percent were in place 15 years later. 83 percent of patients reported continued relief from moderate or severe pain at an average follow up of 12.2 years. The ability of a patient to raise their arm to the side (active abduction) improved an average of 40 degrees. Another study which followed patients with osteoporosis of the shoulder found that 73 percent were very happy with the procedure; 20 percent were satisfied and 7 percent unsatisfied.
Reverse Shoulder Arthroplasty
This is the newest type of surgery for shoulder arthritis which was approved by the FDA in America in 2004. It is often recommended to patients with arthritis of the shoulder coupled with an irreparable rotator cuff tear; as well as those who have experienced previous failed surgeries. A reverse shoulder prosthesis is fixed to the shoulder joint, allowing the arm to be raised overhead even when the rotator cuff muscles are not working. A recent study reported that 78 percent of patients who underwent this surgery were still satisfied or very satisfied 40 months later and 67 percent had none or only slight pain.