In the UK alone, there are thought to be around 10 million people with some form of arthritis. The word ‘arthritis’ means ‘inflammation in the joints’. Shoulder arthritis causes pain and decreased range of motion. It typically affects people who are over 50 years of age, and it is more common among people who have had a shoulder injury.

What causes the condition?

As with the elbow, hands and wrists, there are three common types of arthritis that affect the elbow:

• Osteoarthritis: Is the most common type of shoulder arthritis. Also called wear-and-tear arthritis or degenerative joint disease, osteoarthritis is characterised by progressive wearing away of the joint cartilage. As the protective cartilage surface of the joint is worn away, bare bone is exposed within the shoulder.
• Rheumatoid Arthritis: Another common type of shoulder arthritis, is a systemic autoimmune condition that causes inflammation of the tissue (synovium) that surrounds joints. This inflammation can, over time, invade and destroy the cartilage and bone.
• Post-Traumatic Arthritis (PTA): This typically occurs after a serious shoulder injury or after shoulder surgery. There is also a genetic predisposition for this condition.

What are the typical signs?

Your shoulder joint is a ball-and-socket joint where your arm and the thorax meet. Your shoulder socket is formed by part of your shoulder blade, and your arm bone forms the ball of your shoulder joint. This joint has more movement than any other joint in your body, and when your shoulder becomes arthritic it can be a source of pain and disability.

Shoulder arthritis symptoms tend to progress as the condition worsens, but they might not progress steadily with time. You might have good months and bad months, or your symptoms may change with factors like the weather. Your arthritis symptoms on one particular day may not accurately represent the overall severity of your condition.

The most common symptoms of shoulder arthritis are:

• Pain with activities
• Limited range of motion
• Stiffness of the shoulder
• Swelling of the joint
• Tenderness around the joint
• A feeling of grinding or catching within the joint

How is it diagnosed and treated?

Diagnosis

Your consultant will discuss your symptoms with you and perform a medical examination, during which they will look for tenderness and swelling, and your range of motion as well as identifying what positions cause pain to your shoulder joint. This may be followed by an X-ray which will often show the joint narrowing as well as any loose bodies (e.g. bony pieces). If your pain is due to arthritis following an injury, the X-ray may show an improper joining or a failure to join of the elbow bones.

Treatment

Treatment of shoulder arthritis usually begins with conservative methods. If necessary, more extensive interventions, including surgery, might be necessary.

Non-surgical treatment: 

• Physiotherapy: Stretching and strengthening of the muscles around your shoulder joint may help decrease the burden on your shoulder. Preventing muscle atrophy is an important part of maintaining your use of this joint.
• Anti-inflammatory medications: Anti-inflammatory pain medications include prescription and over-the-counter drugs that help reduce pain and inflammation. Talk to your doctor before taking anti-inflammatory medication for your shoulder arthritis.

• Cortisone injections: Cortisone injections may help decrease inflammation within a joint. While this will not cure your shoulder arthritis, it may diminish the symptoms, including pain.
• Joint supplements (glucosamine): Glucosamine appears to be safe and may be effective for the treatment of shoulder arthritis, but research into these supplements has been limited. Many people experience moderate relief of shoulder arthritis symptoms with glucosamine.

Surgery: if non-operative treatment does not relieve your symptoms, you may be advised to have surgery to clean up the joint (debridement). In the early stages this can usually be carried out using arthroscopy; however, if your arthritis is advanced you may need to have joint replacement surgery (arthroplasty).

• Shoulder arthroscopy: This minimally invasive surgery may be helpful for some symptoms of shoulder arthritis.
• Shoulder replacement surgery: During this procedure, the arthritic cartilage is removed, and a metal and plastic ball-and-socket implant is placed in the shoulder. This can be an option for relief of pain that's associated with severe shoulder arthritis.
• Reverse shoulder replacement: This is the most commonly used shoulder replacement procedure. It gets its name from the fact that the positions of the ball and socket in your joint are switched around. A metal ball is attached to your shoulder blade, where your socket was before. And a new socket is attached to the top of your upper arm, where the ball was before. The new ball and socket each have a stem which, together with special cement, helps anchor them to your bone.

Computer-assisted navigation (CAN) systems

OrthTeam consultants are able to offer patients state-of-the-art minimally invasive surgical solutions, as many of our experts are trained in computer-assisted navigation (CAN) systems. 

This technique can be active, using robotics, or passive where the surgeon remains in total control, but computer software aids in the procedure (which can be pre-operatively and/or during surgery).

The main aim of CAN is to increase surgical accuracy and therefore, minimise the need for revision surgery. Computer-assisted procedures make minimally invasive surgical solutions possible and enable the consultant to obtain information to determine exactly where he/she needs to make incisions before the surgery. Not only does this mean a less invasive treatment and less pain for patients, it also leads to more precision and generally a shorter time in surgery.

CAN shoulder replacement surgery provided by the OrthTeam includes:

• Virtual Implant Positioning (VIP) system
• ExactechGPS – CT guided shoulder replacement system

Recovery

This depends on the type of treatment you’ve had, your consultant will be able to advise you on this.

When can I return to normal activities?

• Work - this depends on your individual employment, however it’s not advised to lift anything with the affected arm for 6 weeks if you’ve had replacement surgery. If you have an active role, your consultant will be able to advise you on a suitable period of time, however it could take up to four months.
• Driving - In general, you'll want to avoid drivinga car for at least six to 12 weeks if you’ve had replacement surgery, or until your consultant has indicated you no longer need to wear a sling.
• Exercise – Your consultant will advise you on what exercise and sports are suitable to return to, and when shoulder.