What Causes Shoulder Arthritis?
According to national health statistics from 2011, 50 million people in the US were diagnosed with arthritis. The most common form of arthritis is osteoarthritis, or “wear and tear” arthritis. Shoulder osteoarthritis is less common than osteoarthritis in the hip and knee joints, as the shoulder is not a weight bearing joint. However, shoulder arthritis is still fairly common.
Stiff shoulder often develops as a result of prior trauma to the shoulder, such as recurrent shoulder dislocations or following a shoulder fracture. It is also more commonly seen in patients who have done a lot of heavy lifting or a lot of repetitive overhead work during their lifetime. As a result of these activities and given how mobile the shoulder joint is, there is increased shear forces across the coating (articular) cartilage covering the ball and socket, and this cartilage then wears away more quickly. When the articular cartilage wears away completely, there is bone on bone contact between the ball and the socket causing pain, inflammation, and loss of range of motion.
More rarely, rheumatoid arthritis–an autoimmune disease arthritis–can develop. Dr. Cunningham is a shoulder specialist at Vail Summit Orthopaedics. He is an expert at diagnosing and treating shoulder arthritis for patients in Vail, Summit County, Aspen, and Denver, CO.
What are Symptoms of Arthritis in the Shoulder?
Pain is the most common symptom of shoulder arthritis, and pain tends to worsen over time. Certain activities, such as overhead sports or overhead lifting, may aggravate the pain. Pain at night is common. Patients also experience decreased range of motion of the shoulder, making it more difficult to do everyday activities. Patients may also notice popping and clicking in the shoulder.
Stiff shoulder can occur in one of two joints:
- Glenohumeral Joint: Arthritis occurs between the ball (humeral head) and socket (glenoid). Patients with glenohumeral joint osteoarthritis commonly localize pain to the back or front of the shoulder. The pain is often described as a deep ache in the back of the shoulder around the scapula area and is often worse at night.
- Acromioclavicular (AC) Joint: This is arthritis in the small joint made up by the clavicle and the acromion, which is an extension off of the scapula. Patients with AC joint arthritis report pain over the top of the shoulder. In some cases, associated pain radiating down into the chest along the clavicle is reported.
How is Arthritis in the Shoulder Diagnosed?
A shoulder specialist would first obtain a patient history, determining when and how the pain started and where the pain is located. Following this, a thorough physical examination of the shoulder should be performed to determine:
- Areas of tenderness about the shoulder
- Active and passive shoulder range of motion measurements
- Rotator Cuff Muscle testing
- Evaluating nerve and vascular function in the upper extremity
Following a physical examination, diagnostic imaging including an xray and possibly an MRI would be performed. Xrays show arthritis very well. On an xray, there would be a decreased space between the ball and socket such that the ball and socket may be touching, indicating bone on bone arthritis. There may also be bone spur formation which is also evidence of arthritis.
How is Shoulder Arthritis Managed?
Initially, patients are prescribed the following nonsurgical treatments:
- Resting the shoulder and limiting overhead work and sports
- Anti-inflammatory medications
- Heat and/or ice treatments
- Physical therapy
- An anti-inflammatory diet with a lot of plant foods and less processed foods
- Joint injections
What are the Types of Injections for Stiff Shoulder?
Joint injections may help temporarily alleviate shoulder arthritis pain. There are several types of injections used:
- Steroid or cortisone injections
- Hyaluronic acid (HA) injections
- Platelet rich plasma (PRP) injections
- Stem cell injections
Steroid injections are useful in quickly reducing pain and swelling in an arthritic shoulder. Within a few days, patients usually report near complete pain relief and improved shoulder range of motion. Steroid injections can provide relief for several months. These injections are covered by insurance.
Hyaluronic acid (HA) injections, also known as viscosupplementation injections, contain HA, which is a protein found in normal articular cartilage. These injections provide shoulder joint lubrication and have an anti-inflammatory effect in an arthritic joint. The FDA has approved HA injections for the treatment of knee arthritis, but these are currently not approved for the treatment of stiff shoulder. As such, insurance does not cover them. However, they have been used for the management of shoulder arthritis for years and can provide good relief for up to 6 months or so.
Platelet rich plasma (PRP) injections have been shown to help decrease inflammation in arthritic joints and help control pain. Currently, insurance is not covering these, as they are considered experimental.
Stem cell injections are not regulated by the FDA. Thus, providers can make unsubstantiated claims about their benefits. Although studies show that stem cell injections do not build new cartilage, there is some evidence that they can decrease inflammation and pain. Currently, insurance is not covering these as they are considered experimental.
What are some good Shoulder Arthritis Exercises?
Exercise is a key component of the non-surgical treatment of shoulder arthritis. Recommended exercises include:
- Aerobic Exercise: For overall fitness, targeted aerobic benefits, and increased blood flow and oxygenation to arthritic joints.
- Range of Motion Exercises: This is essential to preventing or limiting the shoulder stiffness that occurs with stiff shoulder. This involves stretching to help restore more normal flexion, abduction, external and internal rotation of the shoulder joint.
- Gentle Strengthening Exercise: Gently restoring muscle strength to the muscle groups that support and stabilize the shoulder, particularly the rotator cuff and deltoid.
Speak to an orthopedic shoulder specialist or a physical therapist before performing any shoulder arthritis exercises.
What are Shoulder Osteoarthritis Surgical Treatment Options?
If non-surgical treatment of one’s shoulder arthritis is no longer effective and one’s pain is severe, with there being pain preventing sleep and/or limiting activities of daily living, then surgery may be indicated. There are two surgical options that may be recommended depending on the condition:
- Arthroscopy: Mild or moderate glenohumeral arthritis may be treated with arthroscopic shoulder surgery. Typically, the damaged joint is cleaned out–known as a debridement– removing bone spurs and repairing any tearing of the rotator cuff or bicep tendons. Arthroscopy does not cure arthritis and further treatments may be needed later on. However, this can often decrease pain and improve function.
- Shoulder Replacement (Arthroplasty): When stiff shoulder is severe, a shoulder replacement may be recommended. With a shoulder replacement, the damaged humeral head is exchanged for a metal head and the socket is resurfaced with a plastic liner. If there is also tearing of the rotator cuff tendons in addition to stiff shoulder, then a reverse total shoulder arthroplasty may be recommended.
Dr. Cunningham is a shoulder specialist at Vail Summit Orthopaedics and Neurosurgery. He is an expert at diagnosing and treating shoulder arthritis for patients in Vail, Summit County, Aspen, and Denver, CO. Contact Dr. Cunningham today.