suffering from Athritis?
Types of Arthritis
Facts about Arthritis
SHOULDER ARTHRITIS AND OSTEOARTHRITIS TREATMENT
What is shoulder osteoarthritis?
Shoulder osteoarthritis is a type of osteoarthritis (OA) specific to the shoulder joint. OA, also known as degenerative joint disease, is a condition characterized by degeneration of the cartilage that cushions the joint leading to narrowing and fluid accumulation within the joint space and bony growths called osteophytes. These changes can cause joint pain, weakness, and limitation of motion of the affected joint.
Who is at risk for shoulder OA?
Genetic, physiologic, and environmental factors all play a role in the development of OA. Age is the predominant risk factor for OA. More than 70% of people aged 70 and above in the United States are afflicted with OA. Obesity is another risk factor for OA, particularly in the weight-bearing joints. Females are more often afflicted with OA than males. OA also tends to run in families.
Although OA more commonly occurs in weight-bearing joints such as the knees and hips, shoulder OA affects up to one-third of people over 60 years of age. A history of prior shoulder injury, surgery at the shoulder joint, joint infection, bone disease, or congenital shoulder joint anomalies can also predispose a person to shoulder OA.
What are the signs/symptoms of shoulder OA?
Symptoms of shoulder OA include pain, stiffness, a feeling of grinding or catching within the joint, and decreased range of motion and function of the joint. Signs that your doctor may investigate include swelling and tenderness around the joint, crepitus (crackling noise), pain with motion, and limited strength and range of motion of the joint. Shoulder OA symptoms tend to progress as the condition worsens; however, people with shoulder OA may find that their symptoms wax and wane from month to month and with changes in the weather, specifically barometric pressure.
How is shoulder OA diagnosed?
Your health care provider will diagnose shoulder osteoarthritis based on your history and symptoms along with laboratory tests and x-ray findings. X-ray findings include shoulder joint space narrowing, bony growth, and subchondral cysts. The degree of radiologic abnormalities may not necessarily correlate with the severity of your symptoms, so it is important for your health care provider to treat your symptoms rather than just the radiologic findings. Since shoulder pain can occur because of reasons other than OA, your health care provider may also take blood for laboratory tests and aspirate fluid from the shoulder joint using a needle to rule out other possible causes of your pain. Some of these other causes include joint infection, other types of arthritis, or gout.
How is shoulder osteoarthritis treated?
There is no definite cure for shoulder OA, but many options exist for treatment to reduce pain and improve shoulder joint function. Treatments for shoulder OA range from conservative therapy to joint replacement.
Since shoulder OA tends to be aggravated by overuse of the joint, it is important to rest the affected joint and to withhold from excessive activity or weight lifting. If there are certain activities that aggravate the joint, you should avoid those activities when possible. At the same time, it is critical to maintain mobility within the joint. Therefore, it is important to maintain an active lifestyle that incorporates exercise. If you completely stop moving your shoulder, more problems may develop. Therefore, rest is important to give your shoulder a chance to recover, but too much rest will be detrimental. Ultimately, exercise is one of the most important components to treating arthritis.
A variety of medications, both over-the-counter and prescription, may be used to relieve the pain associated with shoulder OA. Acetaminophen (Tylenol) can help reduce the pain associated with shoulder OA but should be used in caution in people with liver disease. Other analgesics commonly used are non-steroidal anti-inflammatory drugs (NSAIDs). The most common of these drugs include ibuprofen and naproxen, which are available over-the-counter. Prescription drugs including meloxicam (Mobic) and celecoxib (Celebrex) are also used to treat OA. These drugs reduce inflammation in the shoulder joint by inhibiting cyclooxygenase (COX) enzymes that are involved in producing inflammatory and pain mediators. A common side effect of these drugs is irritation of the lining of the stomach, for which your doctor may prescribe another drug. Before taking any NSAIDs you should have a full discussion of the risks and benefits with your physician. Other pain medications that may be prescribed by your doctor include tramadol (Ultram) or tramadol/acetaminophen (Ultracet). These medications all have side effects which you should discuss with your doctor before taking them.
Other medications that have been used to treat shoulder OA include glucosamine and chondroitin sulfate supplements. Both are substances naturally found in the body that may help in the repair and maintenance of cartilage. It is thought that oral supplementation with glucosamine and chondroitin sulfate may help with the pain of osteoarthritis when taken over extended periods of time. These compounds may also help to prevent the progression of shoulder OA in people who already have the condition. You should consult with your doctor before taking glucosamine or chondroitin sulfate.
Exercise and Physical Therapy
Although rest is essential so as not to aggravate the shoulder joint, it is also important to maintain muscular tone in the rotator cuff muscles surrounding the shoulder joint through regular exercise. This is important to allow the stress to be primarily absorbed by the muscles and less by the joint when using your shoulder. Your health care provider or physical therapist will recommend certain exercises to strengthen the shoulder joint, and these exercises should be performed regularly to maintain good function of the joint.
Other modalities that your physical therapist may use to reduce pain and swelling include heat or ice packs, ultrasound therapy, electrical stimulation, and massage.
Corticosteroid injections are currently used to treat mild to moderate shoulder OA in patients for whom oral analgesic medications and physical therapy do not work or as an adjunct to physical therapy. Corticosteroids are strong anti-inflammatory medications that work to slow down the accumulation of cells responsible for producing inflammation in the joint space, thereby lessening pain and improving function. These injections are often combined with a pain medication, have a long-lasting effect, and can be performed every 3-4 months, with a maximum of 3-4 per year. Corticosteroid injections are generally well-tolerated, but rarely, may produce an increase in joint swelling and pain for a few days after the injection before symptoms begin to improve. In some patients, corticosteroid injections do not provide relief of symptoms. These injections should not be used in patients with poorly controlled diabetes, as corticosteroids can increase blood sugar levels and worsen the symptoms of diabetes. The risks involved with any injection include bleeding and infection, so your doctor will use sterile technique when performing the injection to minimize these risks.
Treatment of shoulder OA using injections of hyaluronic acid, which has been shown to be effective for knee OA, is currently being studied in clinical trials and may eventually become another option for patients with shoulder OA.
Surgery is reserved for patients with advanced shoulder OA that has not responded to non-operative therapies. There are 3 main types of surgery that can be performed for shoulder OA. The first is arthroscopic surgery in which the surgeon places a small camera within the joint and uses small instruments to remove pieces of loose, broken down cartilage. This surgery is not curative but may reduce the pain of shoulder OA.
The other 2 types of surgery available for people with shoulder OA are shoulder joint replacements (arthroplasty), one partial (hemiarthroplasty) and the other complete (total arthroplasty). More than 10,000 shoulder arthroplasties are performed annually in the United States. Joint replacement entails removing the arthritic portion of the joint and replacing it with a metal and plastic joint. Hemiarthroplasty involves replacing the head of the humerus (the long bone in the upper arm), while total shoulder arthroplasty involves replacing both the head of the humerus and the glenoid fossa, the socket in which the head of the humerus sits. There have been few clinical trials comparing hemiarthroplasty and total arthroplasty, but among those that have been performed, total shoulder arthroplasty was demonstrated to have greater improvement in joint function than hemiarthroplasty over a 2-year period of follow up. Both hemiarthroplasty and total shoulder arthroplasty improved overall quality-of-life in studies of people with shoulder OA.
Authors: Michelle Khan, M.P.H., UMDNJ-Robert Wood Johnson Medical School, Piscataway, NJ.
R. Robert Franks, D.O., Bone and Joint Institute, Cooper University Hospital, Camden, NJ