What is shoulder arthritis?
Shoulder arthritis refers to inflammation of the shoulder joint. It involves deterioration of the smooth cartilage covering the joint surfaces. Damage to this cartilage may be due to:
- normal wear and tear over time
- overuse of the joint
Previous conditions, such as rotator cuff tear, shoulder dislocation or fracture, can lead to shoulder arthritis.
What are the symptoms of shoulder arthritis?
The most common symptoms of arthritis of the shoulder are pain and stiffness. Pain can occur at rest but is often worse with movement. You may find that you can’t move your shoulder as much as you used to, especially when you try to reach above your head. Symptoms may become worse over time.
What does your doctor look for?
Your doctor will take your medical history to look for clues that help make a diagnosis (eg previous injury). Your doctor will also look at how well and how far your shoulder moves in different directions. This is called your range of motion. If you have shoulder arthritis, the affected side commonly has a reduced range of motion compared to the other side. The limited movement can be with both active motion (you moving your shoulder) and with passive motion (your doctor moving your shoulder). Soft tissue and bony swellings may also be obvious.
By carefully examining your shoulder, your doctor can identify what is wrong and how best to treat your problem. The key point when considering treatment options for shoulder arthritis is whether the rotator cuff tendons are intact or damaged. This will make a significant difference to the treatment options possible.
What investigations are needed?
You will need an X-ray to confirm the diagnosis. An MRI is usually required to determine whether the rotator cuff is intact.
When surgery is being considered, a CT and/or MRI scan are needed. These help your doctor plan the approach for surgery, decide which is the most suitable procedure to perform and help with the positioning of implants during surgery.
How is shoulder arthritis treated?
There is no cure for arthritis but there are several very effective treatments. All have the same goals – to control pain and improve the function of the shoulder so that you can move better and get on with everyday living.
- non-drug therapy (eg physiotherapy, exercises, joint care programs)
- medications (egoral anti-inflammatories or joint injections)
Surgery for shoulder arthritis
Surgical options include:
- arthroscopic debridement and treatment of associated problems (such as biceps tendinosis, acromioclavicular joint arthritis and microfracture of the joint)
- shoulder replacement.
Arthroscopy is usually limited to very minor disease and most patients who have established arthritis benefit from a shoulder replacement.
An anatomical shoulder replacement is possible if the rotator cuff tendons are intact and the shoulder is balanced due to the presence of these tendons and muscles holding the shoulder in place. If the rotator cuff tendons are damaged, a reverse total shoulder replacement may be better as this allows good function, even in the absence of an intact rotator cuff.
Shoulder replacement is limited to patients who have low demands on their shoulder and is best performed in patients over 65 years of age. Different options can be discussed with younger patients.
Possible complications with surgery for shoulder arthritis
Most people are happy with the results of surgery, but complications do occur occasionally. Some of the complications specifically related to shoulder arthroplasty are infection, dislocation, need for a revision procedure, nerve or blood vessel injuries and fracture. These are uncommon but must be considered during the discussion of a shoulder replacement.
All replacements, including hip and knee replacements, have a limited lifespan. The lifespan of a shoulder replacement is related to the activities levels of the patient. Our specialists at Orthopaedic Clinics Gold Coast will discuss whether this procedure is suitable for you at your visit.