What is Arthritis?
Arthritis is the process by which the joint is damaged or inflamed
by any number of conditions. In a normal shoulder, the smooth surface
of cartilage lying over the rounded end of the upper arm bone called
the humerus articulates with (glides against) a small dish-like structure
also covered with smooth cartilage, to allow the shoulder to pass through
its wide arc of motion. Trauma (fractures and dislocations) can result
in accelerated wear-out of the shoulder joint. Repetitive microtrauma,
inherited deformities and loose fragments of bone and cartilage likewise
can cause abrasive mechanical deterioration of shoulder joint.
Inflammatory conditions such as rheumatoid arthritis may affect the
shoulder as well as multiple other joints in the body. These inflammatory
processes result from the breakdown of joint cartilage due to an autoimmune-type
Signs and Symptoms of Arthritis
Pain, stiffness and a sense of grinding are the major complaints of
patients with shoulder arthritis. Pain may be present with strenuous
activity, with sudden movements, with change of position while sleeping
at night or with the extremes of shoulder motion. Stiffness and loss
of mobility progress slowly throughout the course of the arthritic process,
but frequently are more pronounced early in the morning. A sense of
grinding, caused by two irregular surfaces rubbing against each other,
is frequently accompanied by pain and stiffness.
How is Arthritis Diagnosed?
The physicians diagnosis of shoulder arthritis is made by history,
physical examination, x-ray studies and in some cases, special imaging
studies. Your doctor will evaluate the degree of mobility, strength
and discomfort present in your shoulder, and evaluate x-rays. The x-rays
usually show loss of the normal cartilage joint space, frequently show
irregular surfaces, irregular peripheral bone growth (spurs), and sometimes
loose fragments of bone within the joint. In some cases, concern regarding
the precise shape of the two joint surfaces may prompt your surgeon
to obtain special imaging studies to provide a more detailed, three
dimensional outline of the shoulder joint.
Common Treatments for Arthritis
Treatment of an arthritic shoulder joint may include exercise, use
of heat, medications, and education in the early stages of inflammation.
When non-operative treatment no longer provides relief, surgery may
be indicated. Surgery may range from arthroscopy to total shoulder replacement
or occasionally arthrodesis (fusion). When the patient is incapacitated
by his or her arthritis, total shoulder replacement arthroplasty can
be performed. In a total shoulder replacement operation, the surgeon
removes the arthritic joint surfaces of the humerus and glenoid, and
replaces them with specially designed, highly polished metal and plastic
substitute components to recreate the mechanics of a more normal shoulder
joint. These components are securely embedded into bone and allow early
participation in a rehabilitation program.
This surgery is usually performed on an inpatient basis and although
transfusion is sometimes required, most patients are candidates to donate
their own blood in advance for use during surgery. Ask your surgeon
if you are a candidate for autologous transfusion.
Phases of rehabilitation include commencement of gentle passive, then
active and finally resistive exercises and ultimately a program designed
to return the individual to an active and productive lifestyle. Maintenance
exercises are frequently recommended to ensure an optimal outcome for
active participation in activities of daily living, productive employment
and many forms of recreational athletics.