The shoulder joint is the most movable joint of the body and therefore easily unstable. One condition that causes pain in your shoulder joint and limits your range of motion is the shoulder arthritis.

Though arthritis of the shoulder has no cure, yet it can be treated effectively, and you can stay active and cope with the pain after undergoing treatment for your arthritic shoulder.

Shoulder Joint Anatomy

Three major bones i.e. your upper arm bone (humerus), your shoulder blade (scapula) and your collarbone (clavicle) make up the two joints i.e. glenohumeral joint and acromioclavicular joint of your shoulder.

The joint where the head of the upper arm bone fits into your shoulder blade socket constitutes your glenohumeral joint and the joint where your collarbone meets the tip of your shoulder blade makes up your acromioclavicular joint.

Either one of your joints or both of them can be affected by arthritis. You can only be treated when your type of arthritis becomes clear. Treatment also varies according to the joint it has affected.

Explanation

There are five types of arthritis that affect the shoulder. Each type of arthritis has its own beginning and stages of progression.

Osteoarthritis

One of the most common types of arthritis, osteoarthritis is also known as the ‘wear and tear’ arthritis. It is a condition in which the covering of the bone i.e. cartilage of your shoulder gets damaged gradually over a period of time.

Once the cartilage gets frayed, the space between the two bones gets reduced. When you move, with damaged cartilage, the bones rub against each other and cause pain, thus resulting in osteoarthritis.

The main cause of osteoarthritis is aging and people more than 50 years of age are usually affected by it. It is more likely to affect your acromioclavicular joint than your glenohumeral joint.

Rheumatoid Arthritis

When the lining of your joints (synovium) that lubricates your joints and makes your movement easy, is attacked by your own healthy cells, it develops an autoimmune condition that is called rheumatoid arthritis.

You may suffer from rheumatoid arthritis in other joints of your body besides your shoulder. The unique characteristic of rheumatoid arthritis is that it affects both your shoulders and is found in both the joints of your shoulder.

Post-traumatic Arthritis

You can get affected by this type of arthritis after having sustained a fracture, heavy impact injury or after shoulder dislocation.

Rotator Cuff Tear Arthropathy

You may get affected by this type of arthritis if the four muscles that make up your rotator cuff sustain a massive tear.  A torn rotator cuff makes the humeral head lose in the glenoid socket. The head, in this case, begins to move upward and can rub against the tip of the shoulder blade, causing damage to the bones thereby resulting in arthritis.  You will feel intense pain and find moving your arm over your head, extremely difficult.

Avascular Necrosis

When the humeral head in your shoulder does not receive adequate blood due to injuries or disease or any other causes, the area dies (necrosis). This condition is called avascular necrosis. It can destroy your shoulder joint by slowly reaching to your glenoid socket, as it progresses in stages.

You can have arthritis in your shoulder because of avascular necrosis. The area that this condition affects in the shoulder is the head of your humerus.  As your humeral head dies, you develop arthritis. Causes of Avascular Necrosis include-

• Overexposure to steroids
• Sickle cell disease
• Overconsumption of alcohol
• Any traumatic injury
• When the cause of avascular Necrosis is unknown, it is known as idiopathic avascular necrosis.

Symptoms

When you have arthritis of the shoulder, your symptoms aggravate with a worsening condition.  You may often be misled by ‘present one month and absent the other’ kind of signs affected by weather changes.

Pain is the most prevalent sign of arthritis of the shoulder. When the arthritis is in the glenohumeral joint, you will feel pain at the back of your shoulder whereas if it is in the acromioclavicular joint then the pain is on the top of your shoulder and may extend to the side of your neck. If both the joints are affected then the pain will extend throughout your shoulder.

Your activity with your arm becomes limited. You may find normal activities like reaching to your back or combing your hair very painful.

You may feel more pain in your shoulder while sleeping at night.

Diagnosis

The diagnosis of arthritis is carried out in two parts i.e. doctor’s examination and imaging tests.

Doctor’s examination- Your doctor will ask you about your medical history and understand the onset of your symptoms. Therein he will examine your shoulder closely and try to look for-

• Muscle weakness
• Soreness or tenderness in your shoulder when touched
• The range of your arm movement with external help and on your own
• Signs of any injury to your surrounding ligaments, tendons, and muscles
• Any pain in the joint when pressed by the doctor
• Any pain in other joints
• The doctor may also inject an anesthetic in your joint to see whether your pain reduces after it.

Imaging Tests- After conducting the physical examination, the doctor will ask you to have your shoulder x-rayed.

X-ray- X-ray helps to show the thorough structure of the bones inside the body. The doctor will come to know the type of arthritis you have by seeing the reduced joint space, the bone spurs and changes in your bone structure.

Treatment

Arthritis of the shoulder is treatable and your shoulder specialist may decide on the treatment method after taking into consideration the type of arthritis you are suffering from.

Non-Surgical Treatment Techniques

Your treatment may begin with non-surgical techniques that include:

NSAIDs- The shoulder doctor may prescribe some non-steroidal anti-inflammatory medications to relieve you from the pain in your shoulder.  If you are suffering from Rheumatoid Arthritis, your doctor may prescribe a disease-modifying drug.

Injectable- Even though the effect of steroid injections is not likely to remain for a very long time, the shoulder doctor may recommend corticosteroid injections to reduce your pain and inflammation.

Lifestyle Alterations- You may be asked to modify your daily activities to help you feel less pain and recommended to avoid using your arm in ways that increase your discomfort.

Physical Therapy Exercises- Your doctor may advise some physical therapy exercises to help you move your shoulder effortlessly, prescribe moist heat treatment or ask you to apply the cold treatment on your shoulder with ice two to three times a day for at least 30 minutes.

Surgical Treatment Techniques

If the pain and the symptoms do not reduce after the non-surgical techniques, your shoulder specialist may recommend surgical intervention. Depending on your symptom progression, your specialist may recommend any one of the following:

Arthroscopy- Milder conditions of glenohumeral arthritis are treated with arthroscopy. After making a small incision, your surgeon will clean out the inner part of the joint. This surgery does not remove the presence of arthritis completely from your shoulder joint and you may need further surgery if your arthritis advances in the future.

Shoulder Joint Replacement- Your specialist will perform a joint replacement surgery if you have advanced glenohumeral arthritis.  He will remove the damaged parts from within your shoulder joint and replace them with artificial parts known as prosthesis.

There are three types of joint replacement surgery:

Hemiarthroplasty- In this surgery, only the head of the upper arm bone (humerus) is replaced with prosthesis.

Total Shoulder Arthroplasty- In this joint replacement surgery, your surgeon will replace the head of the humerus with a metal ball and a plastic cup fitting is inserted in your glenoid.

Reverse Total Shoulder Arthroplasty- This surgery is better for patients who have sustained severe rotator cuff tear in the past. In the surgery, the glenoid is fitted with a metal ball and the plastic cup is attached to the upper end of your upper arm bone i.e. humerus.

Resection Arthroplasty- This surgery is performed on you if you have arthritis of the acromioclavicular joint. Under this intervention, a small part of your bone from the end of the collarbone is removed arthroscopically and space is left that is filled with scar tissue on its own.