Shoulder Arthritis

In Allied Health

Arthritis describes damage to the cartilage in joints. Symptoms vary by individual sufferers depending on the amount of cartilage damage and loss. The main warning sign of potential shoulder arthritis is prolonged pain in the joint with increasing stiffness being an indicator of progressive arthritis.

There are many non-operative treatments for shoulder arthritis including therapy design to promote increased movement, icing the joint, avoiding the more painful activities and medication. There are a number of surgical options available to treat shoulder arthritis if the non-invasive approaches do not deliver adequate relief.

Shoulder Arthritis Defined

Arthritis describes damage to the cartilage we have in all our joints. Our joints have a covering of cartilage, which acts much as Teflon does on a ball bearing. The shoulder is a ball and socket type joint. Cartilage covers the ball of the humerus and also the socket itself in a thin layer two to three millimeters thick.

When cartilage is intact it enables the ball and socket joint to rotate freely in a frictionless environment, avoiding wear and tear to the surface of the bone in the joint. However, as we get older our cartilage degrades and begins to wear down until finally, it exposes the bone leading to bone on bone contact. This is what produces shoulder pain.

Different sections of the cartilage wear at different rates. Once the surface of the cartilage becomes pitted from wear, the deterioration increases. The amount of cartilage loss varies greatly between individuals and as a result, symptoms can vary greatly.

Diagnosing Shoulder Arthritis

Pain in the shoulder joint is the primary sign of arthritis. This pain can present in the front, side or back of the shoulder. In some individuals, pain is present continually while in others pain is linked to actual movement. Arthritis pain can occur mainly in the morning or at night and it may or may not be accompanied by shoulder stiffness. Frequently the pain is worse after exercise or when lifting or carrying heavy objects.

Another sign of progressive arthritis is a loss of motion in the joint preceded by stiffness. As their range of motion declines, sufferers discover their level of pain increases and they can do less with the arm. Finally, as the surface of the cartilage becomes increasingly pitted, patients often feel grinding, cracking or clicking in their joint. Called “crepitus”, this may or may not fell painful and sometimes the joint can lock up entirely and patients can also feel the shoulder slide in some positions due to the uneven surface of the cartilage.

What Is The Prognosis For Shoulder Arthritis?

As every patient’s shoulder joint displays different rates of wear and tear, it is impossible to predict how quickly arthritis will progress. Pain indicates the cartilage is being stressed during that activity. The greater the level of pain, the more likely that activity is further damaging the cartilage and the joint.

What Treatments Are Available?

Initial treatment focuses on motion exercises to prevent the shoulder movement from deteriorating further. If the patient hasn’t lost any range of motion, the objective of this therapy is to prevent further decline. Once the joint becomes stiffer, the pain frequently gets worse and the patient’s ability to exercise declines. To halt or slow down this decline, patients are recommended to stretch for two to three minutes each day, regardless of whether they have experience movement loss. Stretching every day can slow down the rate of loss that accompanies arthritis.

The second step in treating arthritis is to avoid the exercises that are painful. Any painful exercise or movement should be avoided where possible; particularly if afterward the level of pain experienced is severe. If pain continues for several days and wakes the patient at night, that activity needs to be reconsidered given the damage it is doing to the joint. The third stage is to try to contain the pain. Ice packs can help as can heat treatment.

Medication is the next phase of treatment for arthritis. While many medications come with distinct advantages, they also have potential side effects and complications.

What Medication Treats Arthritis?

Most start with acetaminophen as it has few side effects. However, it can cause liver damage if taken in high doses. The next group of medication is non-steroidal anti-inflammatory drugs. They include Naprosyn, Aleve, Motrin, Ibuprofen, Celebrex, and Meloxicam. Some of these are available over the counter and may relieve some arthritis-related pain. These medications are best used sparingly for occasional pain. Long-term use can result in harmful side effects. Consult your physician before using them for any length of time.

The most common side effect of these drugs is gastritis or irritation of the stomach lining, which may even progress to create bleeding ulcer. If you are on blood thinners, do not take these drugs as they make bruising easier and may exacerbate heart conditions.

These drugs can also cause kidney damage in some patients so they should be avoided if the patient suffers from kidney problems, has had a kidney transplant or has only one kidney.

Another alternative is glucosamine or chondroitin sulfate. Available over the counter, it provides temporary relief in around 60 percent of users. However, it is expensive and has to be taken daily. Sometimes cortisone taken orally can help with the temporary relief of symptoms.

The final medication option is pain relievers such as codeine, hydrocodone, oxycodone and other narcotics, which can be, taken as pills or patches. These are predominantly used when the patient does not want surgery or whose condition precludes them from corrective surgery. These narcotics can come with severe side effects including sleepiness, breathing difficulties and constipation. They are also highly addictive, so should be used with caution.

What About Shoulder Injections?

Two types of injections are available for shoulder arthritis and both primarily offer pain relief. Cortisone shots when mixed with a numbing agent such as lidocaine usually give immediate relief. Once the numbing agent wears off, the shoulder may be painful and it is important to ice the shoulder for a few days. Cortisone shots can increase the risk of infection if the patient undergoes shoulder replacement surgery.

Hyaluronic acid is the second form of injection. A naturally occurring lubricant, hyaluronic acid comes as a liquid and has been injected in arthritic knees for many years. This injection may help with pain for a year or two but is rarely longer lasting.

What About Physical Therapy?

Physical therapy for shoulder arthritis is rarely needed, except to reverse a loss of motion in the joint. Good stretching exercises involves a low resistance rubber strap, which can be attached to a door handle or alternatively, a simple pulley system. Strengthening the shoulder is not recommended for shoulder arthritis sufferers as it may exacerbate the symptoms.

Consult Your Physician

Always consult your physician for advice on treatment plans for shoulder arthritis. In particular, medication should only be taken under a physician’s guidance.