Shoulder Arthritis - Types, Clinical Features, Diagnosis, and Treatment

What Is Shoulder Arthritis?

Arthritis is the inflammation of one or more joints. Osteoarthritis (a type of shoulder arthritis) is a condition that destroys the smooth outer covering (articular cartilage) of bone. Therefore, it becomes frayed and rough, and the protective space between the bones gets decreased. Thus, the cartilage surrounding the joints of the bones wears away, resulting in friction between the bones, which is often referred to as bone on bone.

The shoulder joint is commonly referred to as the bigger ball and socket joint named the glenohumeral joint. The cartilage covers both the ball (the humeral head) and the socket (the glenoid). Shoulder arthritis is characterized by the destruction of the superficial and deep layers of the cartilage surrounding the shoulder joint.

What Is the Pathophysiology of Shoulder Arthritis?

Normally, the joints in the body are covered by cartilage to provide smooth contact between bones and to aid in a gliding motion. In the case of arthritis, the cartilage wears away, resulting in direct bone-to-bone contact. The pathophysiology of shoulder arthritis is explained below:

1. The cartilage that covers the joints undergoes wear and tear.

2. The surface of the cartilage becomes irregular.

3. Cartilage gradually becomes thin, thus exposing the surface of the bone.

4. Severe pain might occur due to the rubbing of two bones against each other.

What Are the Types of Shoulder Arthritis?

There are several types of shoulder arthritis. Each type has its own characteristics; however, the exact cause remains unknown.

1. Osteoarthritis - Also known as degenerative arthritis. This is the most common form of arthritis and can also affect other joints besides the shoulder. It is most commonly linked to age-related wear and tears.

2. Rheumatoid Arthritis - It is an autoimmune disorder, which means the immune system attacks the body’s healthy cells and tissues (even the joints of the body). Studies show that rheumatoid arthritis may affect both sides of the shoulder.

3. Post-traumatic Arthritis - If the shoulder is fractured, dislocated, or injured, post-traumatic arthritis may develop.

4. Rotator Cuff Tear Arthropathy - Can develop after a prolonged and massive rotator cuff tear.

5. Shoulder Arthritis Due to Avascular Necrosis - Occurs due to disrupted blood supply to an area of the body, which results in necrosis.

What Are the Clinical Features of Shoulder Arthritis?

• Pain in the shoulder joint.

• Stiffness of the joint.

• Cracking (crepitus), grinding, clicking.

• Decreased range of motion.

• Clicking and grinding noises in the shoulder.

• Tenderness around the joint.

• Swelling of the joint.

• The patients may have symptoms in the shoulder, arm, hand, or fingers as well.

• Shoulder symptoms can also be present in the neck, upper back, shoulder blade, and collarbone area.

• Numbness or tingling sensation occurs as a result of shoulder joint damage.

• Lack of sensation in the shoulder area is also possible.

How Is Shoulder Arthritis Diagnosed?

The doctor will find out the cause of your pain, a detailed medical history, and a physical examination is done for evaluation. Tenderness and swelling are checked, and the range of motion is also evaluated.

1. Blood Tests - The blood examination does not aid in diagnosing shoulder arthritis. However, it shows a rise in erythrocyte sedimentation rate (ESR), indicating inflammation.

2. X-rays - The specialist may order an X-ray to visualize the space between the shoulder joints. The excessive loss of cartilage is determined by the closer contact between the bones.

3. Magnetic Resonance Imaging (MRI) - MRI is helpful in examining the soft tissues around the shoulder joint.

4. Computed Tomography (CT) - It is usually preferred to evaluate the bony structures of the shoulder joint.

What Are the Complications of Shoulder Arthritis?

• It can worsen with time and eventually cause loss of range of motion, making it difficult to lift the arm.

• People having osteoarthritis and inflammatory shoulder arthritis find it difficult to perform daily activities.

How to Treat Shoulder Arthritis?

Physical Therapy: Physical therapy is essential in maintaining or improving range of motion and reducing the shoulder joint’s burden through:

• Stretching exercises.

• Strengthening exercises.

• Activity Modification: Activities that put stress on the joints and arms should be prevented. Shoulder exercise can be beneficial if the shoulder is weak.

• Moist heat may feel more comfortable on the arms.

• Icing the shoulder may reduce inflammation.

• Avoid lifting heavy objects.

• Limit activities that increase shoulder pain.

Medications:

• NSAIDs (Non-steroidal Anti-inflammatory Drugs) - Relieves the pain.

• Corticosteroids - Used to prevent inflammation in the joint and minimize the symptoms and pain as well.

• Injection of Viscosupplementation - Injected in the joints to increase the lubrication of joints.

• Dietary Supplements: Foods rich in vitamins A, D, C, E, and K and antioxidants are helpful in reducing the symptoms of shoulder arthritis.

Surgical Management:

• Shoulder Arthroscopy - This is a minimally invasive surgery and may be helpful for symptoms of shoulder arthritis.

• Shoulder Replacement Surgery - This can be an option for the relief of pain in severe shoulder arthritis.

• Reverse Shoulder Replacement - This reverse technique allows for better function when there is a non-functioning rotator cuff.

• Resection Arthroplasty - A surgical procedure that involves the removal of a minor amount of bone at the end of the clavicle (collarbone). Gradually, scar tissue fills up the space between the shoulder and the clavicle.

How Can Shoulder Arthritis Be Prevented?

Shoulder arthritis may occur due to various factors. Therefore, it is not possible to completely prevent it. However, the risk of developing it may be reduced by:

• Proper weight management.

• Avoid activities that may cause shoulder injury.

• Choose low-impact exercises.

• Eat nutritious foods such as fatty fish, green leafy vegetables, berries, nuts, etc.

Conclusion:

The specialist mainly focuses on minimizing pain, preventing disease progression, and controlling symptoms of shoulder arthritis. In addition, preservation of joint function and reducing the severity of the disease are also essential. Early treatment and diagnosis may be able to prevent tissue damage caused by arthritis. However, the severe forms may be long-lasting, and one can survive them with proper management.