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 WHAT IS SHOULDER ARTHRITIS?


The shoulder is a ball and socket joint, which is affected like the hip and the knee joint by arthritis. The surfaces of the ball and the socket of the shoulder joint are lined by soft cartilage, which is important for the smooth gliding motion of joints. With arthritis this cartilage becomes destroyed causing bone to rub on bone. Eventually extra pieces of bone grow on the edges of the joints. All this leads to pain and stiffness.


WHAT IS THE CAUSE OF SHOULDER ARTHRITIS

 

Osteoarthritis often occurs with no recognisable cause. Rheumatoid arthritis is common cause in the shoulder. It can occur after injuries, which have damaged the cartilage and after recurrent dislocations.

 

WHAT ARE THE SYMPTOMS?

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The main symptom of arthritis is pain which is made worse by movement. This often progresses to pain in the night. The pain is often associated with a creaking sensation within the joint. As the disease progresses there is loss of movement and the joint becomes very stiff.


HOW IS THIS DIAGNOSED?

The diagnosis is usually by a good history, examination and taking plain x-rays. This often shows the loss of the normal space between the ball and socket joint and the presence of extra bone spurs.

   
WHAT IS THE TREATMENT?

 

In the early stages shoulder arthritis is treated with painkilling medication and injections of Cortisone into the joint. It is important to keep the shoulder as mobile as possible. This is done with physiotherapy. Once it reaches a stage where the pain becomes unbearable surgical options are considered.

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The mainstay of surgical treatment is joint replacement. Traditionally the ball and the socket are replaced. The ball is sawn away and a prosthesis is inserted into the upper arm. A plastic cup is introduced into the socket. Both these implants are cemented in.



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It is often possible to perform a different operation which is minimally invasive and preserves a lot of the patients bone. A metal cap is put onto the diseased head of the humerus. This is called a Copeland surface replacement hemiarthroplasty. This can buy a number of years before the routine replacement needs to be performed. If it fails the routine replacement can be performed where the whole head is removed.



Shoulder replacements are mainly for pain although a secondary benefit is to improve movement. Movement clearly depends on the state of the muscles and the tendons around the shoulder and how long they have been inactive. A lot of physiotherapy is often necessary to regain the motion.