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Shoulder

Shoulder Arthritis

What is shoulder osteoarthritis?

Shoulder Osteoarthritis (OA) is a chronic, degenerative joint disease, that results from erosion of the protective articular cartilage found at the ends of bones. As the joint surface degenerates, the subchondral bone remodels, losing its sphericity and congruity. The joint capsule also becomes thickened, leading to further loss of shoulder rotation.

Shoulder Osteoarthritis can affect the acromioclavicular (AC) joint and the glenohumeral joint (ball and socket).

Shoulder Osteoarthritis is more common in the AC joint; however, it is glenohumeral arthritis that causes more dysfunction for patients and can require further treatment.

When people talk about shoulder arthritis, they more than likely are referring to OA of the glenohumeral joint.

Osteoarthritis is the most common form of arthritis. Shoulder osteoarthritis affects up to 33% of patients over the age of 50.

What is rotator cuff arthropathy?

Rotator cuff arthropathy is a special type of shoulder arthritis caused by a chronic full-thickness rotator cuff tear leading to abnormal forces within the shoulder joint. The ball (humeral head) of the shoulder joint eventually shifts up with respect to the socket (glenoid) due to the lack of a functioning rotator cuff. Over time, this shift leads to arthritis.

What are the symptoms of shoulder arthritis?

The primary symptom of shoulder osteoarthritis or rotator cuff arthropathy is pain. As the joint degenerates and the tissues break down, friction increases resulting in inflammation and pain.

In OA of the AC joint, the pain will be concentrated at the top of the shoulder and may radiate into the neck. In OA of the glenohumeral joint or cuff tear arthropathy, the pain is concentrated at the back of the shoulder and can be felt as a deep aching pain.

Other symptoms include:

  • reduced range of motion
  • stiffness that interferes with the activities of daily life
  • crepitus or a grinding sensation with movement

As the arthritis progresses, night pain becomes more common. For many patients, the pain is present at rest and interferes with sleep. In advanced cases, the stiffness creates significant functional limitations.

What causes shoulder osteoarthritis?

Primary OA is a disease of aging but there is a genetic component and primary OA affects women more often than men. Secondary OA, including cuff tear arthropathy, is more frequently found in younger patients who have a history of dislocation and rotator cuff tears. Sports and heavy labor increase the risk of secondary OA.

How is shoulder arthritis diagnosed?

The diagnosis of shoulder arthritis involves a specific set of symptoms, physical examination findings, and changes to the bone, which are visible on radiography. The typical presenting symptom is progressive, activity-related pain that is deep in the joint and often localized.

Patients in the early stages of degenerative joint disease may complain of mild pain and may have unremarkable examinations. Radiography may show only subtle changes to the bone until there is more advanced destruction. The only objective evidence of the disease is articular cartilage wear, which may be shown on magnetic resonance imaging (MRI).

Physical examination will reveal painful crepitus, joint enlargement, and swelling. In severe cases, audible and palpable grinding may occur when a mechanical stress is placed on the shoulder.

Dr. Jonathan Godin will conduct a thorough history and physical exam to assess your shoulder pain and tenderness, muscle strength, mobility, joint enlargement, and whether you have OA in other joints. He will inquire about your symptoms, how long you have been having problems, and whether you have a history of recent shoulder injuries or trauma.

How is shoulder arthritis treated?

Osteoarthritis is a chronic disease. Unfortunately, there is no cure. The goal of treatment is to manage symptoms, including easing pain and preserving mobility and the ability to remain active. Conservative management involves anti-inflammatory medications, topical capsaicin and menthol creams, hot cold therapy, strength training, flexibility exercises, physical therapy, bracing and massage. Corticosteroids injections can aid in pain relief. Other biological injections such as PRP or stem cells can be attempted to treat the inflammation.

If pain and range of motion continue to worsen Dr. Godin may consider surgery as a last resort. Shoulder arthroscopy will help Dr. Godin to view the joint and remove loose pieces of cartilage and bone in the joint. For advanced arthritis, an arthroplasty, or joint replacement can be performed. The head of the shoulder bone is replaced with an artificial “ball” and the glenoid socket is also replaced. For cuff tear arthropathy, a reverse shoulder arthroplasty may be recommended. This procedure differs from a regular shoulder arthroplasty because the artificial ball is placed on the socket as opposed to the humerus. Dr. Godin will discuss the pros and cons of each treatment option, and work with you to develop your unique treatment plan.

Dr. Godin is a board-certified, fellowship trained orthopedic surgeon at the internationally recognized Steadman Clinic in Vail, Colorado. His focus is on his patients and helping them to get well so they can return to the activities that allow them to keep their independence and experience an improved quality of life.


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