GLENOHUMERAL JOINT ARTHRITIS
Glenohumeral (shoulder) arthritis is a common source of pain and disability that affects up to 20% of the older population. Damage to the cartilage surfaces of the glenohumeral joint (the shoulder's "ball-and-socket" structure) is the primary cause of shoulder arthritis.
There are many treatment options for shoulder arthritis, ranging from pain medications and exercises for mild cases, to surgical procedures for severe cases. Treatment decisions are based upon the cause, the symptoms and the severity of the patient's disease. Each year, over 10,000 shoulder replacement surgeries are performed in the United States to relieve pain and improve function for shoulders that are severely damaged by glenohumeral arthritis.
GH JOINT ANATOMY
The most common symptom of arthritis of the shoulder is pain, which is aggravated by activity and progressively worsens.
If the glenohumeral shoulder joint is affected, the pain is centered in the back of the shoulder and may intensify with changes in the weather. Patients complain of an ache deep in the joint.
The pain of arthritis in the acromioclavicular (AC) joint is focused on the top of the shoulder. This pain can sometimes radiate or travel to the side of the neck.
Someone with rheumatoid arthritis may have pain throughout the shoulder if both the glenohumeral and AC joints are affected.
LIMITED RANGE OF MOTION.
Limited motion is another common symptom. It may become more difficult to lift your arm to comb your hair or reach up to a shelf. You may hear a grinding, clicking, or snapping sound (crepitus) as you move your shoulder.
As the disease progresses, any movement of the shoulder causes pain. Night pain is common and sleeping may be difficult.
Glenohumeral joint arthritis is caused by the destruction of the cartilage layer covering the bones in the glenohumeral joint. This creates a bone-on-bone environment, which encourages the body to produce osteophytes (bone spurs). Friction between the humerus and the glenoid increases, so the shoulder no longer moves smoothly or comfortably. As osteophytes develop, motion is gradually lost. A number of conditions can lead to the breakdown of cartilage surfaces:
Wear and tear over time
Trauma (such as a fracture or dislocation)
A chronic (long-standing) inflammatory condition (such as rheumatoid arthritis)
Osteonecrosis (bone death caused by loss of blood supply)
Chronic rotator cuff tears in which the head of the humerus (the upper bone in the arm) loses its proper position in the middle of the glenoid (socket)
Rare congenital and metabolic conditions
Post-surgical changes that can be a result of over-tightening during instability surgery
As with other arthritic conditions, initial treatment of arthritis of the shoulder is nonsurgical. Your doctor may recommend the following treatment options:
Rest or change in activities to avoid provoking pain. You may need to change the way you move your arm to do things.
Physical therapy exercises may improve the range of motion in your shoulder.
Nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin or ibuprofen, may reduce inflammation and pain. These medications can irritate the stomach lining and cause internal bleeding. They should be taken with food. Consult with your doctor before taking over-the-counter NSAIDs if you have a history of ulcers or are taking blood thinning medication.
Corticosteroid injections in the shoulder can dramatically reduce the inflammation and pain. However, the effect is often temporary.
MOIST HEAT & ICE
Ice your shoulder for 20 to 30 minutes two or three times a day to reduce inflammation and ease pain.
If you have rheumatoid arthritis, your doctor may prescribe a disease-modifying drug, such as methotrexate.
Dietary supplements, such as glucosamine and chondroitin sulfate may help relieve pain. (Note: There is little scientific evidence to support the use of glucosamine and chondroitin sulfate to treat arthritis. In addition, the U.S. Food and Drug Administration does not test dietary supplements. These compounds may cause negative interactions with other medications. Always consult your doctor before taking dietary supplements.)
Your doctor may consider surgery if your pain causes disability and is not relieved with nonsurgical options.
Cases of mild glenohumeral arthritis may be treated with arthroscopy, During arthroscopy, the surgeon inserts a small camera, called an arthroscope, into the shoulder joint. The camera displays pictures on a television screen, and the surgeon uses these images to guide miniature surgical instruments.
Because the arthroscope and surgical instruments are thin, the surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.
During the procedure, your surgeon can debride (clean out) the inside of the joint. Although the procedure provides pain relief, it will not eliminate the arthritis from the joint. If the arthritis progresses, further surgery may be needed in the future.
SHOULDER JOINT REPLACEMENT (ARTHROPLASTY).
Advanced arthritis of the glenohumeral joint can be treated with shoulder replacement surgery, in which the damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis.
Replacement surgery options include:
Just the head of the humerus is replaced by an artificial component.
Total shoulder arthroplasty. Both the head of the humerus and the glenoid are replaced. A plastic "cup" is fitted into the glenoid, and a metal "ball" is attached to the top of the humerus.
REVERSE TOTAL SHOULDER ARTHROPLASTY.
In a reverse total shoulder replacement, the socket and metal ball are opposite a conventional total shoulder arthroplasty. The metal ball is fixed to the glenoid and the plastic cup is fixed to the upper end of the humerus. A reverse total shoulder replacement works better for people with cuff tear arthropathy because it relies on different muscles — not the rotator cuff — to move the arm.
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