Paul B. Roache, MD - Orthopaedic Specialist
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In this section:

Arthritis

Arthroscopy

Carpal Tunnel Syndrome

Shoulder Instability

Shoulder Rehibilitation

Tennis Elbow

Rotator Cuff

Cast Care

Healing with R.I.C.E.

Sprains

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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 reaction.

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 physician’s 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.

Aftercare

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.

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