Arthritis refers to an inflammatory condition that affects the joints of our body.
Our joints are designed or developed with a specialized type of cartilage called Hyaline cartilage covering the end of the bone that makes up that joint. This is a very specialized cartilage tissue that allows for very smooth kind of friction-free gliding so that, as you move your shoulder in different directions, there’s very little friction.
Over time, those cells degenerate, and they can be injured for various reasons. We start to lose that smooth surface. When we begin to lose that smooth surface, it results in arthritis.
The downfall with Hyaline cartilage is that you don’t create new articular cartilage throughout your life. It’s a rare commodity or a limited resource.
As arthritis advances, we develop bone spurs and a decreased range of motion. It can also be associated with increased fluid production by the joint, creating swelling, pain, and inflammation.
Arthritis in the shoulder can be a very debilitating or life-altering process because you start to lose that extremity’s function as a result.
Most patients have two common complaints.
First, they have a deep ache or pain in their shoulder, and often that occurs with rest or at night.
Second, they also describe stiffness in the shoulder, which is often worse in the morning when they wake up. Usually, the stiffness will improve a little bit throughout the day. Then at night, it’ll stiffen up again.
Of course, there are varying degrees of pain and stiffness from shoulder arthritis. Some people only have small amounts of motion loss. Others have very stiff, very painful shoulders. There’s a broad spectrum as the disease progresses from mild to moderate to severe arthritis.
Total shoulder replacement surgery is ultimately the end treatment for arthritis in the shoulder.
However, the typical progression from mild to severe shoulder arthritis begins with more conservative treatments.
With shoulder arthritis, the first line of treatment is physical therapy.
We want to maintain as much motion as we can and prevent stiffness. We also want to strengthen all of the muscles surrounding the shoulder joint to keep as much function as possible.
Non-steroidal anti-inflammatory medications can be very beneficial in treating shoulder arthritis.
The main benefit is keeping that inflammation under control so that you have less pain. This allows you to potentially benefit more with physical therapy and stretching exercises.
If the inflammation is well managed, it won’t hurt as much when you’re trying to keep it loose and strengthen the shoulder.
When oral anti-inflammatories are not working, sometimes we will offer an intraarticular cortisone injection.
Cortisone is a naturally occurring substance in your body that is used to combat inflammation.
We use a synthetic form of cortisone, place it within the joint to help decrease the inflammation and fluid production that’s going on as a result of arthritis. This will help improve pain and possibly the range of motion of the shoulder.
We do have to be careful with injections in the shoulder. It is not recommended to undergo multiple cortisone injections in the shoulder. We have to balance the risks and benefits of cortisone injections with treatment objectives and the functional level of the patient.
Other Alternative Treatments
Hyaluronic Acid Injections
With knee arthritis, one of the things that have been tried in recent years is hyaluronic acid injections. This treatment had some improvement with early arthritis in the knee.
However, there is not a lot of good literature or long-term studies that show much benefit with that in shoulder arthritis, so we tend not to use hyaluronic acid injections.
PRP or Stem Cells
There’s also limited evidence to support using things like PRP or stem cells for shoulder arthritis. However, there are not really any large, randomized trials that demonstrate a significant benefit over other treatments such as cortisone injections or oral anti-inflammatories.
Shoulder Replacement Surgery for Arthritis
Once the conservative measures are no longer effective, it’s time to consider shoulder replacement surgery.
If you are experiencing any of the below symptoms, you will want to go ahead and make an appointment to see a doctor.
• Increased loss of function and or motion
• Difficulty sleeping
• Difficulty performing hobbies or activities