Osteoarthritis is known to commonly affect the weight-bearing joints of the body, namely the hip and knee joints.
In most people, however, the shoulders are not considered to be weight bearing, with some notable exceptions such as weightlifters and gymnasts.
The shoulders are often involved in rheumatologic conditions such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Any trauma or infection that affects the shoulder joint can also result in arthritis to that joint.
Arthritis of the shoulder causes symptoms similar to arthritis in other joints. Pain is the most common complaint. Pain is often worsened by activity but patients will often experience a constant lower level of pain.
They may notice this pain more at nights and a common complaint is pain and early morning stiffness. Patients with inflammatory arthritis generally experience stiffness that lasts into the day, whereas the stiffness associated with osteoarthritis goes away once the patient gets moving.
Inflammatory arthritis requires systemic treatment and is best managed by a rheumatologist. Osteoarthritis of the shoulders is managed much like osteoarthritis of the hip and knees. This type of arthritis occurs because of wear and tear in active individuals.
Management begins with activity modification, and avoiding heavy loads across the shoulders if possible. Unfortunately for many young active individuals avoiding such activities is impossible as it is required for their profession, or is undesirable. Young weightlifters and crossfit enthusiasts are ready examples.
Pain medications allow patients to cope with their symptoms, and anti-inflammatory (NSAIDs) medications may help to slow the disease process in inflammatory arthritis. Cortisone injections into the joint are commonly used and may provide relief for months in some individuals. Viscosupplementation has been tried in the shoulder with mixed results.
Severe arthritis of the shoulder is very debilitating, and when managing the symptoms is no longer effective surgical options can be explored. Proper assessment of the shoulder joint with appropriate imaging is essential in planning surgical management. X-Rays and CT scans are important for determining the state of the bone, and an MRI may be necessary if there is any doubt about the state of the rotator cuff.
There is one absolute necessity for any patient that shoulder replacement is being considered. To be a candidate a patient must have a functioning deltoid muscle. Patients younger than 50 years who require shoulder replacement are usually offered a hemiarthroplasty or a humeral head replacement.
In this procedure the part of the shoulder joint formed by the arm bone (humerus) is replaced with a metal head with a stem into the shaft of the humerus. In this procedure the socket portion of the shoulder joint is not replaced. This procedure allows the patient to maintain a relatively active lifestyle, but a metal surface is in contact with the cartilage or bone on the side of the shoulder socket. This can result in pain.
Patients older than 50 years can be offered a total shoulder arthroplasty, where the head of the humerus is replaced and the socket of the shoulder is replaced also. This avoids the problem of a metal component resting against cartilage or bone. One of the major problems encountered with total shoulder replacement is loosening of the shoulder socket. This is more likely to occur in younger more active patients, and is often accompanied by loss of bone from the socket.
Total shoulder arthroplasty and hemiarthroplasty require a functioning rotator cuff to work. For patients with no functioning rotator cuff a reverse shoulder arthroplasty is a viable option. In the procedure the ball of the shoulder is positioned where the socket should be and the socket is placed where the ball would normally be.
Paul Adams is a local orthopaedic surgeon with a fellowship in orthopaedic sports medicine. Email at optimumortho@hotmail.com.