Shoulder Arthritis


Shoulder arthritis

Do you ever worry that a pain or ache around a joint is from arthritis? As we age, we tend to associate random aches and pain with arthritis, but what is arthritis exactly and why does it cause so much pain? Arthritis is a cartilage problem and cartilage is the ultra smooth covering of the ends of your bones inside your joints. It is six times smoother than ice on ice, and it allows your joints to move millions of times without us ever noticing how well cartilage works. That is until the cartilage starts to wear out. Once this happens, the bone underneath becomes exposed, which is very rough. This exposed bone then starts to cause pain, swelling and stiffness in the joints. The joint reacts to the arthritis by forming osteophytes or bone spurs inside the joint. These spurs can become quite large and they will limit the motion of the joint slowly over time. The spurs can also make the joints look like they are swollen. The fingers are the most common joint that will look deformed from arthritis, but the shoulder joint is covered by so much muscle, that the bone spurs are rarely seen. Arthritis of the collarbone, on the other hand, is easy to see because the joint is so close to the skin on top of the shoulder.

There are many causes of arthritis including inflammatory disease, traumatic injury, age, and infection. The most common cause is called osteoarthritis. We do not know the exact cause of the disease, but we do know it occurs more commonly as we age. The most commonly affected joints are the hands, followed by the back, knees, hips, shoulders and ankles. Patients will complain of pain on the side of the shoulder that is made worse with overhead lifting, reaching to the side or behind the back. When the arthritis becomes severe, it can cause constant pain that keeps people up at night. At this point, most patients have limited motion of the shoulder so that they cannot reach to tuck in their shirt or raise the arm behind their head.

The diagnosis can be made by your doctor after a thorough exam of the shoulder and xrays. The xrays will show the arthritis changes in the joint, including the bone spurs. An MRI is rarely needed to make this diagnosis. Unfortunately, an MRI may be ordered without first getting an xray because your doctor is concerned about the rotator cuff. The bone spurs from arthritis can irritate all the structures around the joint including the rotator cuff and the labrum, so it is not uncommon for patients to have small tears in these structures in addition to the arthritis. These small tears do not need to be fixed. It is the arthritis that is causing the pain, not the small tears seen on the MRI.

X-ray of normal shoulderThere are two different joints in the shoulder that can have arthritis, and your doctor can determine which joint is the cause of your pain. The main shoulder joint is where your arm meets your shoulder blade. It is a ball and cup type joint. Arthritis in this joint is not common. The other joint in the shoulder is called the acromioclavicular joint or AC joint. This is the joint between the end of the collar bone and the shoulder blade. The joint is close to the skin and can be felt with a finger in thin patients. Arthritis is commonly seen in this joint, but luckily for most patients, it does not cause pain. Pain from this joint causes pain on the top of the shoulder directly over the end of the collar bone, while pain from arthritis and other shoulder problems cause pain on the side or front of the shoulder.

X-ray of shoulder with severe arthritisThe treatment for arthritis pain in the shoulder joint starts with rest, avoidance of painful motion or activities and heat. Heat can be applied with a heat pad that is warmed in the microwave or uses electricity. Make sure any electrical heating pad you use has an automatic shut off so it does not cause burns when you fall asleep in bed. If those simple treatments do not work, then over the counter pain medications like Tylenol, motrin or aleve can help. Make sure you follow the directions for each medication carefully. If you are taking other medications, ask your doctor to help you chose the best one for you.

There are hundreds of supplements on the market today. I recommend using the arthritistoday.org website to help determine which ones could be useful for your arthritis.

Another good treatment for arthritis of the shoulder is gentle exercise and daily stretching exercises. The more you move the joint, the less likely it will become stiff and tight. Weight lifting or strenuous activity should be avoided because it will likely increase your pain and make things worse.

Steroid injections in the joint can help take away pain on a temporary basis. Artificial joint fluid injections made for the knee joint are currently being studied for the shoulder. At this time, however, those injections have not shown any benefit over a steroid injection.

X-ray of shoulder post surgeryWhen all of the above treatment options have been tried and the arthritis continues to cause significant pain in the shoulder, then a joint replacement is an option to consider. A joint replacement is a surgery that removes the worn out ball and cup and replaces them with a smooth metal ball and plastic cup. These replacements give good pain relief and allow patients to return to normal life with a few limitations on the shoulder. Most people get 70-80% pain relief and function of the shoulder after they recover from the surgery, which takes 6 months of rehabilitation. There are risks involved with any surgery depending on the health of the patient.

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