Shoulder arthritis is an inflammation of your shoulder joint. In can occur in the main joint in your shoulder, the ball-and-socket (glenohumeral joint), or a second small joint where your shoulder blade meets your collarbone (acromioclavicular joint). Arthritis can be a source of debilitant pain and prevent you from using your arm. Arthritis also affects the cartilage, the smooth substance that allows your bones to glide against each other. With time, arthritis leads to cartilage loss. Bones do not have this protective cushion anymore and rub directly against each other.
What causes shoulder arthritis?
There are many different types of shoulder arthritis:
• Osteoarthritis: this is the common one. It is the regular “wear and tear” that people get on their hips and knee. This is the usual age-related joint disease.
• Cuff arthropathy: this is also very common. Is occurs in patients with long-standing rotator cuff tears. The shoulder joint loses its regular balance, the arm bone moves upwards and rubs against the shoulder blade, causing accelerated damage and deformity.
• Rheumatoid arthritis: This is an autoimmune disease, which means your body’s defense system attacks its own healthy tissues. In the shoulder, the immune system attacks the cartilage, causing accelerated wear and tear.
• Post-traumatic: previous injuries, such as fractures or dislocations, can cause accelerated arthritis to the shoulder joint.
• Avascular necrosis: previous injury or disease cut off the blood supply to the head of the humerus (arm bone), causing cartilage damage and arthritis.
Shoulder arthritis occurs in people over their 50s, in the majority of cases. However, it can occur earlier in patients with previous trauma, infection or rheumatoid arthritis. Symptoms of shoulder arthritis may include the following:
• Debilitating pain, at first with activity and in more severe cases at rest
• Stiffness and reduced range of motion
• Inability to perform activities of daily living
• Pain at night & sleep disturbance
• Grinding and cracking as bones rub against each other (crepitus)
The diagnostic process starts with a detailed history and physical exam. Shoulder arthritis is usually evident in shoulder x-rays, unless in a very early stage. More advanced imaging is commonly requested for surgical planning. Dr Panagopoulos may request a CT scan to evaluate the condition of your bones (bone stock). An MRI scan may also be needed to assess the state of your rotator cuff muscles.
Conservative treatment for shoulder arthritis may include:
• Rest
• Activity/lifestyle modification: avoid activities that cause shoulder pain or work around it
• Physiotherapy & a home exercise program: by strengthening your muscles, especially your deltoid, you may find a new balance in everyday activities and reduce pain
• Steroid injection(s): Cortisone reduces inflammation and reduces pain. It may give you relief for a few months or provide you with a leeway if want to push back or avoid surgery for the time being.
If conservative treatment fails, the next step up is surgery. Surgical options for shoulder arthritis include:
• Arthroscopy: it may be of benefit if your arthritis is at an early stage and you still have some cartilage left. Arthroscopic shoulder debridement involves using a tiny camera and small instruments through 2-3 small 4mm skin incisions to “clean up” your shoulder. Bone spurs are shaved off to create more space, tears are repaired, loss bodies can be removed, and the shoulder capsule can be released. Dr Panagopoulos uses a technique called comprehensive arthroscopic management (CAM procedure) that includes all the above. This procedure can provide with long-term release, delaying the need for a formal shoulder replacement for a few years.
• Arthroplasty: There are two main types of shoulder arthroplasty or replacement surgery. In Total Shoulder Arthroplasty (TSA, also called anatomic total shoulder arthroplasty), the surgeon replaces the diseased part of your bones with an implant made out of metal and plastic. The diseased “ball” of your joint is resected and replaced by a metal implant, either stemless or with a small implant, based on the situation. The diseased “socket” is replaced with a plastic cup. This procedure is typically performed in patients with an intact rotator cuff. In Reverse Total Shoulder Arthroplasty (rTSA), the surgeon “reverses” the location of the ball and socket. A metal head attaches to your shoulder blade and a socket attaches to your humerus. This provides a better level arm, improving your range of motion and reducing your pain. This procedure is typically performed in patients with a torn rotator cuff, as a TSA would not work in such cases.
Dr. Panagopoulos has extensive experience in both arthroscopic and shoulder replacement surgery and will discuss all options with you during your visit in the office.
English
Ελληνικά