Anatomy

Also known as "wear-and-tear" arthritis, osteoarthritis is a condition that destroys the smooth outer covering (articular cartilage) of bone. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. During movement, the bones of the joint rub against each other, causing pain.

Symptoms

Pain. The most common symptom of arthritis of the shoulder is pain, which is aggravated by activity and progressively worsens.

• If the glenohumeral shoulder joint is affected, the pain is centered in the back of the shoulder and may intensify with changes in the weather. Patients complain of an ache deep in the joint.
• The pain of arthritis in the acromioclavicular (AC) joint is focused on the top of the shoulder. This pain can sometimes radiate or travel to the side of the neck.
• Someone with rheumatoid arthritis may have pain throughout the shoulder if both the glenohumeral and AC joints are affected.

Limited range of motion. Limited motion is another common symptom. It may become more difficult to lift your arm to comb your hair or reach up to a shelf. You may hear a grinding, clicking, or snapping sound (crepitus) as you move your shoulder.

As the disease progresses, any movement of the shoulder causes pain. Night pain is common and sleeping may be difficult.

Examination

After discussing your symptoms and medical history, your doctor will examine your shoulder.

During the physical examination, your doctor will look for:

• Weakness (atrophy) in the muscles
• Tenderness to touch
• Extent of passive (assisted) and active (self-directed) range of motion
• Any signs of injury to the muscles, tendons, and ligaments surrounding the joint
• Signs of previous injuries
• Involvement of other joints (an indication of rheumatoid arthritis)
• Crepitus (a grating sensation inside the joint) with movement
• Pain when pressure is placed on the joint

X-Rays

X-rays are imaging tests that create detailed pictures of dense structures, like bone. They can help distinguish among various forms of arthritis.

X-rays of an arthritic shoulder will show a narrowing of the joint space, changes in the bone, and the formation of bone spurs (osteophytes).

Nonsurgical Treatment

As with other arthritic conditions, initial treatment of arthritis of the shoulder is nonsurgical. Your doctor may recommend the following treatment options:

• Rest or change in activities to avoid provoking pain. You may need to change the way you move your arm to do things.
• Physical therapy may improve the range of motion in your shoulder.
• Nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin or ibuprofen, may reduce inflammation and pain. These medications can irritate the stomach lining and cause internal bleeding. They should be taken with food. Consult with your doctor before taking over-the-counter NSAIDs if you have a history of ulcers or are taking blood thinning medication.
• Corticosteroid injections in the shoulder can dramatically reduce the inflammation and pain. However, the effect is often temporary.
• Moist heat
• Ice your shoulder for 20 to 30 minutes two or three times a day to reduce inflammation and ease pain.
• If you have rheumatoid arthritis, your doctor may prescribe a disease-modifying drug, such as methotrexate.
• Dietary supplements, such as glucosamine and chondroitin sulfate may help relieve pain.

Surgical Treatment

Your doctor may consider surgery if your pain causes disability and is not relieved with nonsurgical options.

Shoulder Resurfacing

This is a bone preserving procedure that limits the amount of bone removed from the shoulder. This procedure is unique in that the implant design allows patients to resume full activities without restriction after the prescribed rehab protocol.  Many but not all patients resume weight lifting and athletic activity without limitation.

Reverse Total Shoulder Arthroplasty

In a reverse total shoulder replacement, the socket and metal ball are opposite a conventional total shoulder arthroplasty. The metal ball is fixed to the glenoid and the socket is fixed to the upper end of the humerus. A reverse total shoulder replacement works for people with irreparable rotator cuff pathology and arthritis. This technology allows patients without a rotator cuff to regain use of the shoulder.  

Recovery

Surgical treatment of arthritis of the shoulder is generally very effective in reducing pain and restoring motion. Recovery time and rehabilitation plans depend upon the type of surgery performed. Most patients spend 6 weeks in a sling after surgery and progress through a specific rehab protocol.