Shoulder arthritis is a degenerative condition that causes pain, stiffness, and inflammation in the joint. As shoulder arthritis progresses, it can change cartilage and other structures of the shoulder joint. The gradual loss of cartilage eventually causes the two shoulder bones to grind against each other, resulting in pain, stiffness, and inflammation in the joint.
While these degenerative arthritic changes cannot be reversed, many therapeutic options are available to help patients manage pain and stay active. Treatment recommendations often depend on which joint is affected and the type of shoulder arthritis you have.
Your shoulder is made up of three bones: your humerus (upper arm bone), your clavicle (collarbone ), and your scapula (shoulder blade).
The head of the humerus fits into a rounded socket in your scapula. This socket is called the glenoid. A combination of muscles and tendons keeps the humeral head centered in the glenoid. These tissues are collectively called the rotator cuff.
There are two joints in the shoulder, and both may be affected by arthritis. One joint is located where the clavicle meets the tip of the shoulder blade (acromion). This is called the acromioclavicular (AC) joint.
The large ball-and-socket joint of the shoulder (where the head of the humerus fits into the glenoid) is called the glenohumeral joint.
There are five major types of shoulder arthritis, including:
If you have any of the following symptoms for shoulder arthritis, call OrthoMed to schedule a consultation:
During your consultation, your doctor will perform a comprehensive clinical examination to determine if you have shoulder arthritis. He will ask you questions about your medical history, shoulder symptoms, and work and lifestyle activities. He’ll also want to know your goals for your shoulder.
Following the review of your medical history, your doctor will perform a thorough examination of your shoulder. He’ll check your shoulder range of motion and strength, and perform specific tests to make the correct diagnosis.
Additionally, your doctor may order some imaging studies, such as:
X-rays provide detailed pictures of dense structures, like bone. They can help distinguish among various forms of arthritis--they show narrowing of the joint space, changes in the bone, and formation of bone spurs (osteophytes).
MRI (magnetic resonance imaging) provides very detailed images of the soft tissue (cartilage, ligaments, tendons, and muscles) and the bone.
Both nonsurgical and surgical treatment options are available for shoulder arthritis. Conservative treatment may provide pain relief and reduce episodes of inflammation while avoiding the risks of surgery.
Your doctor may recommend surgery, however, if your pain causes significant disability, impairs your desired quality of life, or is not adequately relieved with nonsurgical treatment.
As with other arthritic conditions, initial treatment of shoulder arthritis is usually nonsurgical. Your doctor may recommend the following:
Activity Modification. Modifying your daily activities may dramatically improve your symptoms. This typically involves changing or reducing your activities to avoid pain.
Ice Therapy. Icing your shoulder for 20 to 30 minutes two or three times a day to help reduce inflammation and ease pain.
Warm Compress. Using a warm compress in the mornings to help relieve shoulder stiffness.
Physical Therapy. Stretching and strengthening exercises to help improve and maintain your shoulder’s range of motion while preserving function.
NSAIDs. Taking nonsteroidal anti-inflammatory medications (NSAIDs), such as Motrin, Aleve, or Ibuprofen, to help reduce inflammation and pain. While these medications can be very effective in reducing the inflammation and pain caused by shoulder arthritis, they can also irritate the stomach lining and cause internal bleeding. They should, therefore, be taken with food. Consult your primary care doctor before taking over-the-counter NSAIDs if you have a history of ulcers or are taking blood-thinning medication.
Corticosteroid Injection. Having a steroid injection can dramatically reduce the inflammation and pain caused by shoulder arthritis. The injection usually comprises a combination of a corticosteroid and a local anesthetic. The injection is performed during your clinic visit with your doctor.
If you don’t respond to conservative treatment, surgical treatment options, such as the following, may be necessary to relieve your osteoarthritis symptoms.
Shoulder Arthroscopy. Cases of mild shoulder arthritis may be treated with an arthroscopic procedure called a “CAM procedure” (CAM = Comprehensive Arthroscopic Management of glenohumeral osteoarthritis). Shoulder arthroscopy is minimally invasive and removes loose pieces of damaged cartilage and debrides (cleans out) the inside of your shoulder joint. Although the procedure provides pain relief, it will not eliminate arthritis from the joint or cure your arthritis. If arthritis progresses, further surgery may be needed in the future.
Shoulder Replacement. Advanced arthritis of the glenohumeral joint can be treated with shoulder replacement surgery, in which the damaged cartilaginous surfaces of the shoulder joint are removed and replaced with artificial components. This is called a total joint replacement, and it replaces both the head of the humerus and the glenoid. The ball-and-socket joint of the shoulder is replaced with an artificial one made of metal and plastic.
Reverse Total Shoulder Replacement. A reverse shoulder replacement is performed by positioning the socket and metal ball opposite that of conventional total shoulder replacement. A metal ball is fixed to the glenoid (socket), and a plastic cup is fixed to the upper end of the humerus. A reverse total shoulder replacement works well for certain conditions such as cuff tear arthropathy and certain types of fractures.
Hemiarthroplasty. A hemiarthroplasty is a partial joint replacement where one-half of the shoulder joint, the humeral head, is replaced with a prosthesis, and the glenoid (socket) is left intact.
If you suffer from shoulder arthritis or have a painful shoulder and need relief, seek advice and an accurate diagnosis. Call OrthoMed at (209) 524-4438 to schedule a consultation with one of our orthopedic surgeons. You may also request an appointment online.
If your doctor recommends that you have a cortisone injection for your shoulder arthritis, you can expect the following:
Protect the injection site for a day or two. For example, if you received a cortisone shot in your shoulder, avoid heavy or repetitive overhead lifting for 24 to 48 hours.
It is normal to have some increased discomfort in the injected site for the first 24 to 48 hours. Apply ice to the injection site 20 minutes at a time, 3 to 4 times a day as needed to relieve pain. Heat is generally not helpful in relieving the discomfort from the injection as it increases the inflammatory response.
For injection site soreness during the initial 24-48 hours, you may take the pain reliever acetaminophen (Tylenol). Limit this to a total of 3000 mg throughout 24 hours, and do not take it if you have liver disease. You may also take an anti-inflammatory such as Aleve, Advil, Motrin, or Ibuprofen if you are not taking a blood thinner (Plavix, Coumadin, Eliquis, etc.), do not have bleeding tendencies, ulcers, acid reflux, etc., and you are not already taking other anti-inflammatory medications such as Meloxicam (Mobic), Celebrex (Celecoxib), Piroxicam (Feldene), etc. If you have any concerns, please talk to your orthopedic surgeon or primary care physician before taking these medications.
Watch for signs of infection such as increasing pain, redness, and swelling lasting more than 48 hours. If you notice any signs of infection following your joint injection (fever greater than 101.5 degrees, redness, warmth, drainage), call OrthoMed’s office immediately at (209) 524-4438.
You may shower immediately after the injection but do not soak in a bathtub, hot tub, or whirlpool for 48 hours.
If you have diabetes, a cortisone shot might temporarily increase your blood sugar levels. Be sure to monitor your glucose levels very closely in the 5 days following the injection. Your glucose levels should return to normal over this time. If they do not, please contact your primary care doctor.
The injection may also cause some patients to experience temporary redness and a feeling of warmth of the chest and face (called "flushing").
Some people have a temporary increase in pain for 1 to 3 days after the injection, commonly referred to as a “steroid flare,” caused by crystallization of the cortisone. Rest, ice, and over-the-counter pain medicines may help relieve this temporary discomfort.
Additionally, there is a small risk of bleeding and a slight chance of infection when the skin is punctured, even with a very small, sterile needle.
Cortisone shots commonly cause a transient flare in pain and inflammation for up to 48 hours after the injection. Rest and ice are helpful to lessen the discomfort during this time. After that, the pain and inflammation of the injected joint should decrease, and these results can last up to several months.
Depending upon your particular medical condition and your response to a previous injection, your doctor may recommend that an injection be repeated after a safe amount of time has elapsed. Typically, he will wait 4 to 6 months before repeating injections to prevent tissue damage or weakening over time.
1335 Coffee Road Suite #101
Modesto, CA 95355
Phone: (209) 524-4438
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