Shoulder - Arthritis
Arthritis is inflammation of a joint. Over time, the loss of the smooth covering on the ends of bones (aka - articular cartilage) causes pain and stiffness. This can lead to pain with motion or at rest, clicking or grinding and a loss of strength. When the cartilage is damaged or decreased, the bones rub together during joint motion, resulting in “bone-on-bone” arthritis. When arthritis becomes severe, inflammation occurs around the joint and extra bone is formed in an attempt to protect the joint, resulting in limited motion and strength.
What are the causes?
The primary cause of arthritis is osteoarthritis (aka – “wear and tear” arthritis). Trauma and other illnesses like rheumatoid arthritis, systemic lupus, septic arthritis and psoriasis can result in degeneration of a joint, leading to symptoms of pain and lack of motion.
What are the symptoms?
Patients suffering from glenohumeral joint (GH) arthritis experience pain (sometimes at night), stiffness and loss of strength. A 'grinding', 'clicking' or 'locking' sensation may be felt in the shoulder. Loss of motion can become severe, and the patient may have trouble performing everyday tasks, such as placing objects on shelves or combing their hair.
How is it diagnosed?
Arthritis is diagnosed by your physician based on physical exam and X-rays. Your orthopedic surgeon will examine your shoulder, noting the range of motion, strength and pain with motion. Your surgeon may order additional diagnostic tests such as an MRI to further evaluate the shoulder.
Non-operative
Shoulder arthritis can be treated with physical therapy, to strengthen the muscles that support the joint. Aggressive physical therapy is not suggested for advanced shoulder arthritis, as it may aggravate symptoms. Your surgeon may prescribe anti-inflammatory medication or offer an injection to reduce the inflammation. Certain nutritional supplements may be beneficial to decrease pain and inflammation, such as glucosamine and chondroitin.
Rest and changing the activities that are inciting the pain. You may need to change the way you move your arms to do things. Corticosteroid injections can also be utilized to decrease the pain in the shoulder. These usually work very well, however the effect is usually temporary. Heat can help reduce pain by increasing circulation.
Platelet-rich plasma (PRP) injection is another non operative option for treating pain. Blood is taken from your arm and is spun down to get the healthiest healing factors - platelets and serum. The goal is to promote an anti-inflammatory effect, reduce pain, and stimulate healing. There is also the potential for joint preservation by slowing down the arthritic process. Although one injection may help, studies support a series of 2 injections, 1 x Week/2 weeks. Not covered by insurance.
Bone Marrow Concentrate "Stem Cell" Injections is another non operative option for treating pain. Bone marrow is aspirated from your pelvis and centrifuged in a special kit to concentrate stem cells, which are then re-injected into the joint. The goals are to change the living micro-environment of the joint to a positive one, and to decrease inflammation and cartilage cell death. Will promote healing of cartilage, will not re-grow cartilage, restore joint space, or remove bone spurs. There is also great potential for joint preservation by slowing down the arthritic process in early stages. Not covered by insurance.
Operative
When non-operative treatment no longer is able to relieve symptoms, surgery may be indicated in certain situations.
The definitive treatment for GH arthritis is shoulder replacement surgery. Your surgeon will resurface the ends of the bone where the cartilage has worn away, with metal and plastic implants.
The essential part of the surgery is to remove the damaged area and replace it with a shoulder prosthesis (artificial joint). In order to get to the shoulder joint, an incision is made on the front of your shoulder. After exposing the shoulder joint, the damaged ends of the humerus and glenoid bones are removed. The bone is then prepared to accept the components of the artificial joint. The artificial joint is made of metal, usually a titanium or a cobalt-chrome alloy. The stem is placed inside the humerus bone. Bone cement may be used to secure the stem within the humerus. The glenoid component is made of a special plastic (polyethylene). The glenoid is cemented into place. Not all patients require a glenoid component and the final decision to use a glenoid component is made during the surgery by the surgeon. After the components are in place, the shoulder joint is checked to make sure it is stable and has the potential for good motion after rehabilitation.
Total shoulder arthroplasty
Both the ball and socket are replaced. A cup is fitted to the glenoid and a ball is fitted to the humerus.
Reverse shoulder arthroplasty
In a reverse shoulder arthroplasty the ball and socket are opposite as traditional total shoulder arthroplasty. The metal ball is fixed to the glenoid and the cup is fixed to the humerus. This is utilized in people with a rotator cuff tear. This implant relies on the deltoid to lift the arm rather than the rotator cuff.
Surgical treatment of shoulder arthritis is generally very effective in reducing pain and improving motion. Recovery time and physical therapy plans vary depending on the surgery
Complications.
As with all surgeries, there are some risks and possible complications. Potential problems after shoulder surgery include infection, excessive bleeding, blood clots, and damage to nerves and arteries. There are also associated risks with anesthesia used during surgery.
Your surgeon will discuss the possible complications with you before your operation.
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