Nagging shoulder pain and stiffness, a creaking or clicking sound with movement, night pain—these symptoms of shoulder arthritis should not be ignored. Why not just tough it out? Because patients who promptly care for inflammation of this joint have better outcomes, even if shoulder replacement should become necessary, says shoulder surgeon R. Michael Greiwe, M.D.
Osteoarthritis is the most common type of shoulder arthritis, resulting from everyday wear and tear, says Dr. Greiwe. Rheumatoid arthritis, an autoimmune disease, also causes shoulder arthritis. Beyond these two leading causes of shoulder arthritis are several other conditions: post-traumatic arthritis or avascular necrosis initiated by injury to the shoulder;inflammatory arthritis, such as gout; septic arthritis from infection;capsulorrhaphy arthropathy from past surgical techniques to “tighten” the shoulder; and rotator cuff tear arthropathy. Though shoulder arthritis is common among active people 40-70 years of age, weight lifters seem to wear out their joints and damage cartilage to a greater degree than other athletes, notes Dr. Greiwe.
After determining what type of arthritis is ailing a patient, Dr. Greiwe advises activity modification. “I recommend that patients change some of their overhead activities.” In many instances, “continuing to play tennis or swim or weight lift may not be the best option,” though some movement is essential for keeping the joint mobile and stimulating the cartilage, he emphasizes. Patients must not stop moving the shoulder altogether, “because the stiffer the shoulder is at the beginning, the harder it is to get motion back in the end,” he says.
Anti-inflammatory medication such as ibuprofen is useful, Dr. Greiwe states, but if more relief is necessary, patients are given prescription-strength medicines and advised to add a chondroitin-glucosamine formulation. Those who continue to experience pain are evaluated further and may proceed with a cortisone injection to treat inflammation.
Replacement Options and Outcome
For some, joint damage and pain are sufficient enough to consider a total shoulder replacement, which involves removing the ball and socket and replacing it with a metal ball and a plastic socket. Most patients will regain most of their function, and their pain will be relieved after this procedure. Arthritic patients without a rotator cuff may benefit from a reverse shoulder replacement. With this technique, “we actually take the ball and we put it on the socket side, and we take the socket and put it on the ball side,” explains Dr. Greiwe. These patients should have improved function of the shoulder but will not necessarily have a full range of motion, he notes. Both procedures involve a short hospital stay and post-operative physical therapy. Most patients are functioning well after three months.
Shoulder care and replacement “is one of the last frontiers in orthopaedics,” Dr. Greiwe says. Newer, minimally invasive surgical techniques, together with smaller prosthetic parts (with less metal), should benefit patients shortly. He is particularly excited about a “rotator cuff sparing total shoulder replacement” technique that will make recovery even quicker.
Michael Greiwe, M.D., specializes in shoulder treatment and replacement, rotator cuff repair and labral repair. He is Director of Research at Commonwealth Orthopaedics and consultant to an NIH grant on tendon research and development.