Arthritis is a common word used to refer to any joint pain or joint disease. Shoulder Arthritis is a painful condition of the shoulder. Shoulder being the most mobile joint of the body undergoes a lot of wear and tear. When the protective cartilage surrounding the bone breaks down, it can cause shoulder arthritis. The most common symptom of shoulder arthritis is pain and inflammation.
Shoulder Arthritis and its types
Shoulder Arthritis and its types
There are 5 common types of Shoulder Arthritis:
1.Rheumatoid Arthritis
Rheumatoid Arthritis is a chronic long-term auto-immune disease that affects the lining of the shoulder joints. It does not affect the cartilage between the joints. Auto-immune disease means the body’s immune system which is supposed to defend the body by attacking foreign element like viruses and bacteria mistakenly start attacking the joints. Chronic inflammation during Rheumatoid Arthritis can cause permanent joint destruction and deformity. Rheumatoid factor is an antibody that can be found in most of the patients with Rheumatoid Arthritis.
The exact cause of rheumatoid arthritis is not known however it is believed to be a result of combination of genetic and environmental factors.
2.Osteoarthritis
It is most classic type of Arthritis which is a degenerative joint disease caused because of wear and tear of the shoulder due to age or trauma. Older people, over the age of 50, are generally susceptible to develop osteoarthritis. Shoulder osteoarthritis involve two primary processes:
The cartilage in the joints break down and
Bony growths called osteophytes develop in the joint which causes friction
Osteoarthritis is more commonly found in the Acromioclavicular (AC) joint.
3.Post-traumatic Arthritis
This type of arthritis is caused post an injury. Shoulder fractures and shoulder dislocations may often lead to post-traumatic arthritis. Injuries due to sports and other accidents may also lead to this type of arthritis. Car accidents are reported to be the most common ways of getting post-traumatic arthritis.
After certain injuries, the bones may not heal the way they are normally supposed to heal. This then affects how the joint works and moves which puts additional pressure on the cartilage. Overall, it will cause wear and tear of the shoulder joints.
4.Avascular Necrosis
Avascular Necrosis is a condition where a portion of the bone of humeral head looses its blood supply and dies. Various terms are used for Avascular Necrosis as follows:
Osteonecrosis
Ischemic Necrosis
Aseptic Necrosis
Bone infarction
In the shoulder joint, there is continuous process of remodeling of bones. Old bone dies and new bones are formed. However, due to loss of blood supply in the bone of the humeral head, the cells that produce new bone die. Without the formation of new bone, the old structure looses strength and collapses thus affecting the normal functioning of the shoulder joint. This is called Avascular Necrosis.
5.Rotator Cuff Tear Arthropathy
Rotator Cuff is made up of four muscles that surround the humeral head of the shoulder. These muscles are attached to the bone by tendons. Due to age or injury, the rotator cuff develops tear. If tears are left untreated, they enlarge and involve a larger portion of the rotator cuff. The muscles will be no longer attached to the bone and this affects the shoulder strength and stability which leads to Rotator Cuff Tear Arthropathy. Not all cuff tears leads to cuff tear arthropathy. The factors that causes certain patients to develop arthritis is not fully understood.
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Q&As on Shoulder Arthritis
- What are the different types of shoulder arthritis?
There are 5 different forms of shoulder arthritis. These are rheumatoid arthritis, osteoarthritis, post-traumatic arthritis, avascular necrosis and rotator cuff tear arthropathy.
Rheumatoid arthritis affects both sides of the shoulder. It causes joint swelling and stiffness.
Osteoarthritis is the most common form of shoulder arthritis and is caused by cartilage damage at the ends of the bone.
Post-traumatic arthritis occurs after a dislocation or fracture. This condition can become chronic.
Avascular necrosis is also called osteonecrosis, and can occur in any bone if body supply is compromised. It occurs in the shoulder when there is disruption of blood supply to the head of the humerus.
Injury to rotator cuff causes rotator cuff arthropathy.
- How is shoulder arthritis diagnosed?
The most common sign of shoulder arthritis is pain in the shoulder region, although the type of pain and the timing may vary. There may be deep pain in the shoulder joint or radiating pain around the side of their neck.
The patient has a limited range of movement, stiffness, tenderness and grating sensation.
The doctor discusses these symptoms. The doctor will then ask for an X-ray of the shoulder joint to see if any changes have occurred.
To confirm the diagnosis, the doctor may inject a local anesthetic into the joint where the pain seems to be radiating. If the pain is temporarily relieved, arthritis is likely.
- How is shoulder arthritis treated?
Shoulder arthritis is treated as per the diagnosis, symptoms and disease progression. You may need physical therapy, heat and cold treatment, use of NSAIDs like ibuprofen, disease modifying drugs like methotrexate in case of rheumatoid arthritis and injections of corticosteroids like cortisone to subside pain and inflammation.
There are also a number of surgical options like Arthroscopy, joint replacement surgery (also called arthroplasty) and resection arthroplasty.
Arthroscopy is done for milder forms of arthritis using an instrument with a camera called an arthroscope.
In shoulder replacement surgery, an artificial prosthetic joint is placed.
- What to expect after surgical intervention?
There will inflammation and bruising in the arm and hand due to bruising in the shoulder. The arm will be immobilized with the help of sling or cast. Some exercises are needed to perform to prevent formation of blood clots, assist in healing and to strengthen the muscle. The patient will need assistance in household chores. After 2-4 weeks, physical therapy begins to restore strength of muscles.The patient may resume normal work after 3 months without any assistance. It takes 6 months to one year to heal, varies patient to patient.
- What are the complications of joint replacement surgery?
There are many potential complications of joint replacement surgery. These include infection, blood loss, nerve injury or failure of prosthetic component.
Infection is the most common complication. Though, with perioperative and intraoperative antibiotics, the chances of infection have declined drastically.
Blood loss may occur during surgery and transfusion may be required.
Nerve injury causes pain and restriction of movement but heals on its own after some time.
The shoulder prosthetic joint may fail and removal may be required.
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