“This information is meant only as a guide to help you understand and your treatment options. It is not a substitute for a consultation with a specialist Orthopaedic Shoulder Surgeon. We strongly recommend a thorough discussion with your surgeon about the most appropriate treatment about your problem.” 

Shoulder Arthritis

Shoulder Arthritis

Arthritis means destruction of the smooth lining (or articular cartilage) of a joint. Just like any other joint in the body, the shoulder can also develop arthritis. 

There are two important joints in the shoulder which can develop painful arthritis – the main ball and socket joint of the shoulder (gleno-humeral joint); and the joint at the top of the shoulder – between the shoulder blade and the collar bone (acromio-clavicular joint). For more information about normal shoulder structure and function, see the section on shoulder anatomy. Keep reading to find out more about the causes, symptoms, diagnosis and treatment of the two important forms of shoulder arthritis.  

Gleno-humeral arthritis : This occurs between the ball and socket of the shoulder. Click here to know more about Shoulder Anatomy

Symptoms of Gleno-humeral Arthritis

There will be a gradual pain around the shoulder, and restriction of movement of the shoulder. In  the early stages, this can cause difficulty in everyday activities like lifting your arm above shoulder level for combing and washing your hair, or wearing clothes. Reaching behind your back will also be difficult. In severe cases, there is rest pain and sleep might also be disturbed. Sometimes there can be clicking or creaking sounds on movement of the shoulder.

Causes of Gleno-humeral Arthritis

There are different causes why a joint can develop arthritis. We will focus on some common causes in this section.  

  1. Primary Osteoarthritis: There is no specific cause in this type of arthritis. The risk of developing it is age related, and is seen in the elderly. This is fortunately rare in India. 
  2. Post-traumatic arthritis: This type of arthritis is caused by fractures or dislocations of the shoulder. This type of arthritis can occur in younger people. It usually takes a few months to years after the injury for this to set in.
  3. Cuff tear arthritis: This is a specific type of arthritis in the shoulder, which is seen in long standing cases with tears of the rotator cuff. The rotator cuff is an envelope of tendons which stabilise the ball and socket of the shoulder.  Once this stabilising function is lost, the ball of the shoulder does not remain centred in its socket and is prone to develop arthritis.
  4. Rheumatoid and other inflammatory arthritides can also sometimes affect the shoulder.
  5. Septic arthritis occurs when there is infection and pus within the shoulder joint. It is fortunately rare, but is a surgical emergency whenever it occurs.

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Shoulder Arthritis Diagnosis

After a detailed history and clinical evaluation is essential to determine the severity and cause of the arthritis. As a first step, your shoulder surgeon will ask for an X-ray of the shoulder. This will not only confirm the diagnosis, but also rule out other causes of the pain. Blood tests will help identify any underlying Rheumatoid arthritis or inflammatory arthritis. Depending on the stage of the arthritis and severity of the symptoms, a CT scan or an MRI scan will also be requested, especially if surgical treatment options are being considered.

Shoulder Arthritis Treatment

This information is meant only as a guide to help you understand and your treatment options. It is not a substitute for a consultation with a specialist Orthopaedic Shoulder Surgeon. 

We strongly recommend a thorough discussion with your surgeon about the most appropriate treatment about your shoulder arthritis.

 Non-operative treatment is usually tried to begin with. They consist of:

  1. Activity modification – for example, wearing buttoned shirts instead of t-shirts.
  2. Painkiller and anti-inflammatory medication. These include aceclofenac, paracetamol and ibuprofen. Please check with your doctor about the safety of these medicines, as long term use can cause side effects.
  3. Physiotherapy – this is an important component of the first line of treatment of shoulder arthritis. It strengthens the muscles around your shoulder, and helps significantly in the early stages. At The Shoulder Centre, we have a team of experienced and internationally trained musculo-skeletal and sports physiotherapists to help you.
  4. Injections into the shoulder joint – Sometimes your surgeon might recommend steroid injection into the shoulder. Steroid helps temporarily suppress inflammation and pain arising from the shoulder. At The Shoulder Centre, we use Ultrasound guidance to increase the accuracy of these injections. (Please visit our section on injections around the shoulder for more information).

Operative treatment in the form of surgery is recommended only when other options fail to relieve your pain. Various options exist depending on the cause and stage of arthritis. At The Shoulder Centre, we pride ourself in being patient centric. Our experienced shoulder surgeons will discuss the pros and cons of each, keeping in mind your specific symptoms and requirements.

  1. Arthroscopic debridement – In specific patients with early stages of arthritis, a “clean-up” of the joint through key-hole surgery can improve pain and increase movement. For more information about arthroscopy, please see our page about arthroscopy.
  2. Comprehensive Arthroscopic Management (CAM) – suitable for arthritis occuring in younger patients. 
  3. Shoulder Joint Replacement – Just like the hip or knee joints, the damaged ends of the shoulder bones can be replaced. It is reserved for severe arthritis in which there is significant pain and disability. There are two types of replacements – anatomical (which is done when the rotator cuff is intact), and reverse (which is done when the rotator cuff is deficient). Please speak to your shoulder surgeon about which type is best suited for you.
  4. Arthrodesis or joint fusion – it is more of a historical procedure in which the shoulder joint is “fused”, eliminating both pain and movement at the shoulder. 

A special mention of Suprascapular nerve block and ablation is needed here. It is useful in special cases where there is severe pain in the badly damaged arthritic shoulder, and the patient is not fit for surgery due to other medical problems. The nerve which is responsible for carrying pain signals from the shoulder to the brain is “switched off”. There is improvement in pain, but there is also significant loss of power in the shoulder.

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Looking to learn more about Sports Injury, Shoulder FracturesShoulder Dislocations, Frozen Shoulder, Subacromial Impingement, Rotator Cuff Tears . Take a look at our Patient education guide

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