Arthritis in the Shoulder

Selected Features of Our Program

Evaluation and Diagnosis

Arthritis of a joint occurs when the protective cartilage layer wears away. The joint then becomes more painful and loses motion. People with shoulder arthritis may feel catching, grinding, and stiffness especially with overhead activities. Eventually all the cartilage will be gone with bone grinding against bone. This process takes years. Arthritis comes in three flavors: osteoarthritis, post-traumatic arthritis and inflammatory arthritis. Osteoarthritis is simply wear and tear as the body ages and only affects older patients. Osteoarthritis in the shoulder is uncommon in patients who have not had any previous injuries. Post-traumatic arthritis results from a fracture or dislocation of the shoulder that damages the cartilage and causes it to wear out faster than normal. There are many special inflammatory arthritis conditions such as rheumatoid arthritis that can cause especially severe damage to joints in fairly young patients. These inflammatory arthritis conditions require special laboratory tests on blood samples to make the diagnosis. The other two types of arthritis can be diagnosed by simple office examination and x-ray. Damage to the rotator cuff tendons that move the shoulder joint can promote arthritis. Sometimes an MRI scan may be taken to look at these tendons and assist in planning treatment.

Treatment and Recovery

All arthritis treatment starts with the basics of a non-surgical program. Therapy includes gentle range of motion exercises, thermal modalities, and strengthening. Oral anti-inflammatory medication and injected cortisone help with pain considerably. Injections are given either into the shoulder joint itself or the bursa on top of the joint and under the shoulder blade. Modifying how certain key activities are performed takes much of the stress off the joint. A small proportion of patients will require some form of surgical treatment. The simplest form is called arthroscopy and requires only a few tiny holes around the joint. A fiber-optic camera and other instruments are used to clean up damaged areas and take pressure away in key locations. Rehabilitation after this type of surgery is rapid with few restrictions. When shoulder arthritis is more severe, a metal prosthesis may be used to replace the "ball" at the top of the arm bone but leave the "socket" of the shoulder blade alone. This is called a "hemi-arthroplasty". In even more severe cases both the "ball" and the "socket" are replaced with prosthetic parts. This is called a "total joint replacement". The surgery requires an overnight hospital stay. After surgery the arm is kept in a sling. Gentle range of motion exercises under the direction of a therapist is started a few days after surgery. More motion is gradually allowed after the first 6 weeks and strengthening is begun around 2 months after surgery. Excellent pain relief and improvement of function can be expected.