The shoulder is the most mobile joint in the human body, with a complex arrangement of structures working together to provide the necessary movement. The shoulder is a ball-and-socket joint made up of three bones: the humerus (the bone in the upper arm), the scapula (the shoulder blade), and the clavicle (the collarbone). A strong network of soft tissues and bones work cohesively to provide movement and stability to the shoulder. The head of the humerus fits into a shallow socket in the scapula with the shoulder capsule, which is a strong connective tissue, surrounds the shoulder joint. Synovial fluid lubricates the joint and the shoulder capsule to ease the movement of the shoulder. This socket is called the glenoid and a combination of tendons and muscles, called the rotator cuff, center the humerus in the glenoid, which is the shoulder socket.
There are two joints in the shoulder, both of which can be affected by arthritis. The acromioclavicular joint (AC joint) is located where the clavicle meets the tip of the scapula. The glenohumeral joint is located where the head of the humerus fits into the scapula. There are many forms of arthritis with five major types that typically affect the glenohumeral joint:
Osteoarthritis - Osteoarthritis is the most common form of arthritis and occurs when the protective cartilage on the ends of your bones wears down over time. It’s often called a degenerative joint disease where the cartilage experiences a significant amount of wear and tear over a long period of time, generally occurring in individuals over the age of 50.
Rheumatoid Arthritis (RA) - Rheumatoid arthritis is quite possibly the most serious form of arthritis as it is a major crippling disorder. Unlike osteoarthritis, rheumatoid arthritis affects the synovial membrane (lining of the joints), causing a painful swelling, resulting in joint deformity and bone erosion. Rheumatoid arthritis is three to four times more likely to occur in women and may affect various systems of the body such as eyes, heart, lungs, skin, and the nervous system.
Post-Traumatic Arthritis - Traumatic arthritis is caused by a major or repeated trauma to the articular cartilage. This is most common among individuals who were/are athletic or active. Injuries to joints such as a fracture or dislocation can cause major damage to the articular cartilage, which leads to arthritic changes in the joint over time.
Avascular Necrosis - Avascular necrosis occurs when the blood supply to the head of the humerus is limited or disrupted due to an injury such as a dislocation or fracture. It can also be a complication from some medications. The lack of blood can cause the bone to breakdown and damage the articular cartilage, resulting in arthritis. This can also occur spontaneously without an injury.
Rotator Cuff Tear Arthopathy - Rotator cuff tear arthopathy is the development of arthritis as a result of a long-standing, large tear in the rotator cuff. When this occurs, the torn rotator cuff is no longer able to hold the head of the humerus in the glenoid socket, causing the ball to ride up, out of the socket. This can damage the surfaces of the bones and cause arthritis.
Individuals who are experience glenohumeral arthritis typically have the following signs and symptoms:
- Pain that increases with activity and progressively gets worse
- Limited or restricted range of motion in the shoulder joint
- Pain that interferes with sleep,rest, and day-to-day activities
- Popping, grinding, or crunching in the shoulder
- A sense of stiffness in the shoulder
If conditions worsen or are persistent despite the use of medication and physical therapy, a visit to a physician is highly recommended to identify the cause of the pain and avoid further complications.
Glenohumeral arthritis is diagnosed with a combination of patient history, physical examination and imaging studies. After discussing the individual's symptoms, the physician will examine the shoulder for weakness, tenderness, pain, and limitation of both passive and active range of motion. The physician willthen order an X-ray to examine narrowing of the joint space, changes in the bones, or the formation of bone spurs, and confirm the diagnosis of glenohumeral arthritis. In some cases, the physician may also order a CT scan or MRI scan to rule out other shoulder joint conditions.
As with most arthritic conditions, the initial treatment for glenohumeral arthritis will be more conservative, non-operative methods. If non-operative treatments fail to reduce symptoms or pain, the physician may recommend an operative treatment approach.
Rest - It is advised to decrease or completely stop the activity that makes the pain worse. A great way to stay active while allowing the symptoms to subside is to switch to low-impact, cross-training activities such as biking or elliptical machine.
Ice - Placing ice (with a barrier such as a towel) on the most painful areas of the shoulder for up to 30 minutes (less if the skin becomes numb), two to three times a day can diminish the pain and keep the swelling down.
Medication - Over-the-counter medication such as ibuprofen and naproxen usually help reduce pain and swelling.
Physical Therapy - Physical Therapists will often prescribe specific strengthening and range of motion exercises that maintain as much mobility in the shoulder joint as possible. It is crucial that these exercises be done accurately and routinely to optimize recovery of the mobility of the shoulder joint.
Steroid Injections - Injecting the shoulder joint with cortisone-like medications, a powerful anti-inflammatory medicine, may aide in decreasing pain and improving shoulder mobility.
Dietary Supplements - Non-prescription supplements such as Glucosamine and chondroitin sulfate may help relieve pain, but it’s crucial that these be recommended by the physician as they may cause negative interactions with other medications.
Surgery - If shoulder pain persists and the non-operative treatments have been exhausted, the physician may recommend an operative approach. The exact procedure will vary based on the extent of damage and the cause of the pain.
- Shoulder Arthroplasty (Replacement) - When glenohumeral arthritis reaches the advanced stages, shoulder replacement surgery may become necessary. This procedure involves the removal of one (hemiarthroplasty) or both sides (total shoulder arthroplasty/ reverse total shoulder arthroplasty) of the glenohumeral joint and replacing them with man-made prosthetic implants, generally made of metal alloys, high-grade plastics and polymers. Not everyone is a candidate for this procedure, so it’s important to discuss options with the physician.
Regardless of the treatment approach taken, patients go through a rehabilitation program which includes physical therapy exercises that are crucial to restore range of motion, strength, and function. Each patient is unique, so the therapy program will vary based on his/her level of pain, extent of injury, and desired level of activity. Recovery time after surgery depends on the complexity of the procedure, but the individual's commitment to following all the exercises prescribed by the physical therapist is the most important factor in returning to all the desired activities.
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