The term arthritis literally means inflammation of a joint, but it is generally used to describe any condition in which there is damage to the cartilage, the tissue that lines the ends of bones in a joint. When the damage is to the cartilage in the shoulder joint, it is called shoulder arthritis. Inflammation is the body’s natural response to injury and presents as redness, swelling, heat and pain.
There are different types of arthritis, the most common of which are osteoarthritis and rheumatoid arthritis.
Osteoarthritis, also called degenerative joint disease (DJD), is the most common type of arthritis, and occurs most often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing painful bone-on-bone contact. Bone spurs may develop where bony areas bulge or stick out at the end of a joint.
Anatomy of the Shoulder Joint
The shoulder consists of 2 joints formed by 3 bones. The humerus or upper arm bone articulates with a cavity at the side of the shoulder blade called the glenoid to form a ball and socket joint called the glenohumeral joint. The clavicle (collar bone) and a bony process at the top of the shoulder blade called the acromion join to form the acromioclavicular joint. The ends of all articulating bones are covered by smooth tissue called articular cartilage which allows the bones to slide over each other without friction. Articular cartilage reduces pressure and acts as a shock absorber during movement of the shoulder bones. The joint is covered by a thin lining membrane called the synovium which produces a fluid that helps keep the joint lubricated.
Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to excessive strain over prolonged periods of time, or due to other joint diseases, injury or deformity.
Primary osteoarthritis is commonly associated with ageing and general degeneration of joints. Secondary osteoarthritis is generally the consequence of another disease or condition, such as repeated trauma or surgery to the affected joint, or abnormal joint structures from birth.
Arthritis can cause pain and stiffness making it difficult to perform activities involving movement of the shoulder.
Symptoms vary according to the form of arthritis. Each form affects the body differently. Arthritic symptoms generally include swelling and pain or tenderness in joints for more than two weeks, redness or heat in a joint, limitation of motion of a joint, and early morning stiffness.
Osteoarthritis causes joint pain and can limit a person’s normal range of motion (the ability to freely move and bend a joint). When severe, the shoulder joint may lose all movement, making it difficult to perform activities of daily living.
The proportion of cartilage damage and inflammation varies with the type and stage of arthritis. Usually the pain early on is due to inflammation. In the later stages, when the cartilage is worn away, most of the pain comes from the mechanical friction of bones rubbing on each other.
Doctors diagnose arthritis with a medical history, physical exam and X-rays of the affected part. Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are also performed to diagnose arthritis.
If shoulder arthritis remains untreated the pain and stiffness can become severe and disabling, affecting sleep and preventing one from carrying out routine activities. This can lead to frustration, depression, anxiety, and anger thus affecting quality of life.
There is no cure for arthritis, so beware of ‘miracle cures’. Your doctor may prescribe anti-inflammatory medicine. Occupational therapy or physical therapy, which includes exercises and heat treatment, may be recommended. In severe cases, surgery may be suggested. Surgery commonly performed for shoulder arthritis includes arthroscopy and arthroplasty.
Before surgery, you will receive a complete medical evaluation. Your doctor will discuss your surgery in detail. You should notify your doctor of any allergies or any medications you are taking. You may be asked to stop taking certain medication prior to surgery. A physical therapist will discuss rehabilitation. You may have to arrange for someone to drive you home and will need help with certain activities following surgery.
Surgery is usually performed under general anesthesia. Arthroscopy is recommended for mild cases of shoulder arthritis. During this procedure, a slender tube with a camera called an arthroscope is inserted into the shoulder joint. Magnified images are displayed on a screen and help guide your surgeon to carry out the procedure using miniature surgical instruments. A few small incisions are made to admit the arthroscope and instruments into the joint. During arthroscopy, your surgeon debrides or cleans out the shoulder joint, which can often relieve pain though it does not eliminate the arthritis.
Arthroplasty is recommended for advanced shoulder arthritis and involves removal of the damaged parts of the shoulder joint and replacement with artificial components. The head of the humerus may be replaced by a metal ball. A plastic cup-shaped implant may be used to replace the glenoid surface.
Your doctor may choose to perform a hemiarthroplasty where only part of the shoulder joint is replaced or a total shoulder arthroplasty where the entire joint is replaced. The ball and socket components are sometimes reversed by fixing the ball to the glenoid and the cup to the humerus. This is more beneficial for certain conditions. In cases of arthritis of the acromioclavicular joint, the end of the clavicle may be resected and left to form scar tissue. This procedure may be performed arthroscopically.
The type of surgery will depend on your condition and severity of the disease, your age and general health. In the elderly with severe arthritis, joint replacement can provide good results.
The length of your hospital stay will depend on the kind of procedure you have. Recovery is quicker following arthroscopic surgery and you will usually be discharged after spending a few hours in recovery. Following arthroplasty, you will remain in the hospital at least a day or two. Your doctor will place you on antibiotics and pain killers. Your shoulder is immobilized in a sling for 2-4 weeks. You will experience some pain for which medications are prescribed. Depending on your level of pain, you may receive anti-inflammatory medications, local anesthetics or opioids. Applying ice to the shoulder can also relieve pain and swelling. If your pain does not resolve within a few weeks you should notify your doctor. Avoid smoking as it can delay the healing of tissues.
Outcome of Shoulder Osteoarthritis Surgery
You should have less pain and improved shoulder strength and function as a result of surgery. Occasionally complications such as infection, nerve injury and problems with the implants can occur.
Recovery After Shoulder Osteoarthritis Surgery
A rehabilitation program can help you regain shoulder strength and movement and get you back to your daily routine. Soon after the operation you will begin with passive exercises to improve movement of the joint. Later, more active exercises as well as strengthening exercises for the shoulder are introduced.
Down-time, lifestyle or off-work duration
Following arthroscopic repair, you can usually return to work in a few days or weeks depending on the nature of the procedure. Complete recovery can take a few months. In cases of arthroplasty, recovery may take 4-6 months and depends on various factors including the extent of the injury, your age, your adherence to post-op instructions and physical therapy etc.
Prognosis following Shoulder Osteoarthritis Surgery
Although surgery is usually successful at relieving pain and improving function, return to activities such as sports may take a while. One may occasionally develop weakness, stiffness or chronic pain.