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What is shoulder arthritis?

Shoulder Anatomy and Treatment Options

 

Shoulder arthritis is a common condition affecting patients as they get older. Although history, physical exam, and imaging support diagnosis, arthritis should not be a frightening diagnosis and is part of life as we age.

What are the Anatomical Structures I should be aware of in the shoulder?

Below is some information about the anatomy of the shoulder. The ‘shoulder joint’ is the interface between 2 primary bones:

1. Upper arm bone (Humerus)
2. Shoulder Blade (Scapula)


The ends of these two bones (humeral head and glenoid) are held together by a group of thick ligaments, called a joint capsule. Ligaments are strong bands of tissue that provide stability to joints, connecting bones to other bones, preventing them from moving too much and too far.

On the ends of each bone are cartilage; a tough yet flexible cushioning that allows the bones to smoothly glide on top of one another as you move. Similarly, between the upper arm bone and shoulder blade is a thick ring-shaped piece of cartilage called the labrum. This piece of tissue provides further stability to the shoulder, providing a suction mechanism, hugging the humeral head close to the glenoid.

On top of these components are tendons and muscles, including the important group called the rotator cuff. Tendons are strong pieces of fibrous connective tissue that attach muscles to bones. As you activate your muscles, the force is transferred to tendons, which ultimately enables you to move your bones!

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How do I know If I have shoulder arthritis?

Shoulder arthritis pain can be pain in the shoulder or referred to the neck or elbow. The pain can fluctuate early on in the disease. Shoulder arthritis is progressive and can worsen with overuse of activities. Sometimes, patients will report symptoms of stiffness, pain early in the morning that improves with activity, and pain at night. If you have these symptoms and are interfering with daily activities or are getting worse a physician can get an x-ray to see if there is arthritis. Arthritis is very common and is a normal part of aging. It is very common to see 50-70% of patients over the age of 50 with some sort of arthritis.

What is proper treatment for shoulder arthritis?

When the shoulder is weak or overused, there can be some loss of the cartilage that lines the bones. This is the beginning of osteoarthritis which causes the bones to get closer together. The first step in managing osteoarthritis of the shoulder is physical therapy to strengthen the rotator cuff muscles to lift the bones off of each other.

If physical therapy does not improve you pain or ability to perform activities, the next step is to consider injection. There are cortisone injections and orthobiologic injections. Cortisone is covered by insurance and decreases inflammation in the shoulder joint so you can strengthen the shoulder muscles in physical therapy. Cortisone can be short term and you do not want to repeat it more than 3 times in a year. Other injections to consider are orthobiologics. Orthobiologics include Platelet Rich Plasma (PRP), and microfragmented fat. Please speak with your physician to see if you are a candidate with these procedures. They can help with reducing pain and increasing function. In one case series for shoulder arthritis performed at Harvard, microfragmented fat showed improvement in pain and activities. These injections are being researched and there is some promising evidence, but they are not covered by insurance and take several weeks to recover.

If injections do not provide relief, the next procedure to consider is a shoulder replacement. There are two types of shoulder replacements include a total shoulder replacement and a reverse shoulder replacement. Depending on if your rotator cuff tendons are torn, that determines what type of shoulder replacement you might be a candidate for.


Reference:

1. Cadogan, Angela et al. A prospective study of shoulder pain in primary care: prevalence
of imaged pathology and response to guided diagnostic blocks. BMC musculoskeletal
disorders vol. 12 119. 28 May. 2011.

Lipogems | Rotator Cuff and Arthritis from Harvard http://www.mltj.online/wp-content/uploads/2020/10/393-398.pdf

 

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