Glenohumeral Arthritis

There are two joints in the shoulder and both may be affected by arthritis. The Acromioclavicular (AC) joint is where the clavicle meets the tip of the shoulder blade (acromion). The Glenohumeral joint is where the head of the humerus fits into the scapula.

Glenohumeral Arthritis is caused by the destruction of cartilage covering the bones in the glenohumeral joint. This causes bone-on-bone friction affecting the smooth movement of the shoulder. Glenohumeral Arthritis is most commonly seen in people over 50 years. It is estimated that it affects 20% of older population.

Symptoms of Shoulder Arthritis

The most common symptom of any Shoulder Arthritis is pain. Other symptoms include tenderness in the shoulder, limited range of motion, weakness. Patients will have trouble doing everyday activities particularly reaching overhead,

Causes of Glenohumeral Arthritis

Osteoarthritis
Rheumatoid Arthritis
Wear and Tear
Trauma
Infection
Osteonecrosis
Rotator Cuff Tears
Repetitive strain and overuse of shoulder
Excessive use of steroid medication

Diagnosis of Glenohumeral Arthritis

Glenohumeral Arthritis is diagnosed by using a combination of patient history, physical examination and X-Rays. In some cases, CT scan or MRI scan or ultrasonography will be done.

Shoulder Arthritis Treatment:

Different treatment options work best for different patients. As with other shoulder conditions, the course of treatment starts with standard non-operative method which includes the following:

Rest
Warm or cold compress
Non-steroidal anti-inflammatory drugs (NSADs)
Physical Therapy
Steroid Injections (in cases where it is needed)

Most patients with mild Glenohumeral Arthritis, experience reduced pain and improvement in the shoulder functions within 4-6 weeks following conservative non-surgical treatment.

Surgery for Shoulder Osteoarthritis

Only if the non-surgical treatment options do not give the desired results, Surgical treatments are offered:

Various options of surgery are available depending on the severity and location of the arthritis. Most common type of surgery is Shoulder Arthroscopy where loose pieces of damaged cartilages are removed. In some cases, Shoulder Osteotomy is preferred. This is done to shave off osteophytes and reduce friction between the bones.

In cases of severe arthritis, where the patient’s rotator cuffs are functioning – shoulder replacement is recommended

In cases of severe arthritis, where the patient’s rotator cuffs are not functioning – reverse total shoulder replacement is recommended.

In cases where the arthritis is isolated humeral head, often hemiarthroplasty or partial shoulder replacement is recommended.

Post-operative Rehabilitation

Rehabilitation program will vary based on the severity of the condition and the treatment option chosen. The aim is to restore range of motion, strength and function. Recovery time after the surgery depends on the complexity of the procedure. In general it includes the following:

Soon after the surgery, patients are placed into a sling.
Certain activities are prohibited for certain duration
Physical Therapy is prescribed

In Shoulder Replacement surgeries , recovery can require 3 to 6 months of intensive physical therapy.

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Q&As on Glenohumeral Arthritis

What are the signs and symptoms of glenohumeral arthritis?

The most common symptom of glenohumeral arthritis is pain due to rubbing of bones within the shoulder joint.

The pain increases with time, gradually over years. It is commonly present at night, and interferes with sleep. The other common symptom is loss of motion because of chronic inflammation, pain and disuse of the shoulder joint, fractures or previous surgeries. There may be weakness of supporting muscles. Disuse may cause wasting away of shoulder muscles. Swelling and tenderness may also be present. You may hear crepitus (clicking or crunching sound) during movement of the shoulder joint.

How is glenohumeral arthritis diagnosed?

The doctor will ask your medical history and discuss symptoms. Most patients report an increase in pain over years. The doctor will ask if you have any other conditions like previous trauma or surgery to the shoulder, an infection in the shoulder, previous rotator cuff injury or rheumatoid arthritis in other joints. The doctor will do a physical examination of the shoulder to check if other deformities exist. The doctor may ask to go for imaging techniques like X-ray, CT scan, MRI of the shoulder to confirm a diagnosis of glenohumeral arthritis. X-ray will show irregularity of the joint surface, osteophytes and bone erosion.

How is glenohumeral arthritis treated?

The treatment of glenohumeral arthritis depends on the severity. Mild glenohumeral arthritis is often treated by rest, NSAIDS (non-steroidal anti-inflammatory medicines) – such as ibuprofen or naproxen, exercises to increase range of motion and strength whereas mild to moderate glenohumeral arthritis pain is controlled by corticosteroid injections (cortisone shots) for cases that do not respond to NSAIDS.

Glucosamine and chondroitin are also helpful as they aid in cartilage formation. Viscosupplementation therapy cushions the joint surfaces. Hyaluronic acid is injected directly into the joint to improve joint lubrication and reduce friction during movement. If glenohumeral arthritis is severe, operative treatment is recommended. Debridement surgery and Shoulder Arthroplasty (replacement of shoulder joint).

What are the complications that occur after surgery?

The potential complications that occur after surgery are bleeding, nerve injury and infection. Nowadays perioperative antibiotics and intraoperative antibiotics are given which have reduced chances of infection.If infection is chronic, that is present for more than 6-12 weeks, it requires the removal of the implant.

Blood loss is another common complication during shoulder replacement surgery and you may require transfusion.

Nerve injury can also occur during shoulder replacement surgery but they are usually temporary. Normal functioning returns over time.

Component failure also occurs and is more common with the glenoid component of a total shoulder arthroplasty.

How much time does it take to recover?

Recovery may vary patient to patient.

The patient, physician, and physical therapist requires to work together in order to have good and fast results.

During the first 6-8 weeks after surgery, the shoulder is immobilized with a sling or a cast.

A passive range of motion exercises should be performed to prevent stiffness as it maintains functional motion in the shoulder.

After 6-8 weeks, when soft tissues are healed, an active range of motion can start.

Afterwards, a strengthening program begins, focusing on the rotator cuff muscles and those that strengthen the scapula.

A maintenance program of shoulder exercises for whole life is recommended.Complete recovery usually takes 4-6 months.