What is it?
Shoulder arthritis is the loss of the normal cartilage surfaces that provide painless range of motion of the shoulder. The main joint of the shoulder in consideration here is the glenohumeral joint, the ball and socket joint made from the meeting of the humerus and the scapula, or shoulder blade.
What causes it?
Shoulder arthritis can develop from many causes. Normal wear and tear, or osteoarthritis, can accumulate over time. Rotator cuff tears can, over time, lead to arthritis of the joint. Trauma and instability to the joint can accelerate arthritis. Lastly, systemic conditions, such as rheumatoid arthritis, can lead to glenohumeral arthritis.
How is it diagnosed?
A history and physical exam is important to understand the patient’s complaints, the severity of symptoms, to evaluate the range of motion and strength of the shoulder. Xrays are useful to confirm the presence and extent of arthritis, and to evaluate for rotator cuff tears and other associated pathology. Oftentimes a CT scan or MRI are obtained to better evaluate the joint, the severity of arthritis, bony deformity, and the integrity of the rotator cuff.
How is it treated?
A conservative treatment regimen can improve pain and function in shoulder arthritis. It typically involves oral medication such as NSAIDS and Tylenol, steroid injections, and physical therapy.
When conservative therapy is insufficient to address the symptoms of shoulder arthritis, surgery is recommended. Arthroscopy of the shoulder allows minimally invasive access to the joint. Through this access, the degree of arthritis can be assessed, and debridement of bone spurs and cartilage flaps can be performed. Loose bodies can be removed, and other conditions such as bursitis can be treated.
When arthritis is more advanced the more reliable surgical treatment is shoulder replacement. Total shoulder arthroplasty involves the removal of arthritic cartilage from the ball and socket portions of the joint and replacement with implants that recreate the joint with a metal and plastic articulation. Another type of implant called a reverse shoulder arthroplasty also replaces the joint with a metal and plastic articulation, but reverses the normal placement of the ball and socket. This allows the shoulder to function well despite a torn or deficient rotator cuff.
Both of these procedures reliably improve pain, function, and quality of life. Recovery usually involves an overnight stay in the hospital and a period of immobilization followed by therapy. Healing may take 3-6 months, and regaining full strength and motion can take up to a year.
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