Shoulder Arthritis

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.

Anatomy of the Shoulder

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.

Are there different types of shoulder arthritis?

There are five major types of shoulder arthritis, including:

  1. Osteoarthritis, also known as "wear-and-tear" arthritis, destroys the smooth outer covering (articular cartilage) of bone. As the cartilage wears away, the cushioning of the shoulder disappears, and the cartilage becomes frayed and rough. As a result, the protective space between the bones decreases. During movement, the bones of the joint rub against each other, causing friction, inflammation, and pain. Osteoarthritis typically affects people over 50 years of age and tends to run in families, indicating that there is likely a genetic component to the disease process.
  2. Rheumatoid Arthritis (RA) is a chronic disease that attacks multiple joints throughout the body. It is symmetrical, meaning that it usually affects both shoulders. The joints of your body are covered with a lining — called synovium — that lubricates the joint and facilitates movement. Rheumatoid arthritis causes this lining to swell, which causes pain and stiffness in the joint. Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its tissues. In RA, the defenses that usually protect the body from infection damage normal tissue (such as cartilage and ligaments) and soften bone.
  3. Posttraumatic Arthritis is a form of osteoarthritis that develops after an injury, such as a fracture or dislocation of the shoulder.
  4. Cuff Tear Arthropathy can develop after a large, long-standing rotator cuff tear. The torn rotator cuff no longer holds the head of the humerus centered in the glenoid, and the humerus moves upward and rubs against the acromion. This action damages the surfaces of the bones, causing arthritis to develop over time. The combination of a large rotator cuff tear and advanced arthritis can lead to severe pain and weakness, and patients may not be able to lift their arm away from their side or use their arm for any activity requiring strength.
  5. Avascular Necrosis (AVN) of the shoulder is a painful condition that occurs when the blood supply to the head of the humerus is disrupted. Because bone cells die without a blood supply, AVN can ultimately lead to the destruction of the shoulder joint and the development of arthritis. Avascular necrosis develops in stages. The dead bone gradually collapses as it progresses, damaging the articular cartilage covering the bone and leading to arthritis. At first, AVN affects only the humeral head, but as AVN progresses, the collapsed humeral head can damage the glenoid. Causes of AVN include high dose steroid use, heavy alcohol consumption, sickle cell disease, and traumatic injury, such as fractures of the shoulder. In some cases, no cause can be identified.

When should you see a doctor for shoulder arthritis?

If you have any of the following symptoms for shoulder arthritis, call OrthoMed to schedule a consultation: 

  • Gradually increasing pain in the shoulder (typically described as a deep ache), aggravated by activity and movement
  • Night pain
  • Decreased range of motion
  • Shoulder weakness (typically due to pain)
  • A sensation of popping, clicking, or catching in the shoulder when attempting to move it

How is shoulder arthritis diagnosed?

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.

What is the treatment for shoulder arthritis?

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.

Nonsurgical Treatment Options

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.

Surgical Treatment Options

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.

Shoulder Arthritis Treatment in Modesto, CA

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.

Cortisone Injection FAQs

What can you expect with a cortisone injection?

If your doctor recommends that you have a cortisone injection for your shoulder arthritis, you can expect the following:

  • You may need to change into a gown to allow ease of access to the joint being injected. You will be positioned so that your doctor can easily insert the needle.  
  • The area around the injection site will be cleaned with chlorhexidine gluconate soap and isopropyl alcohol. 
  • A cold anesthetic spray called "ethyl chloride" will numb the area locally before the injection. This feels like a very cold ice cube being applied to the skin.  
  • You will likely feel pressure when the needle is inserted. Let your doctor know if you have a lot of discomfort, and he will make adjustments.
  • The medication is then released into the joint through the needle. This can cause an additional sensation of pressure and occasionally a temporary burning feeling.   
  • A band-aid will be applied over the injection site. 

Are there aftercare instructions for a cortisone shot?

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.

Are there any risks in getting a cortisone shot?

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.

What kind of results can you expect from a cortisone shot?

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.

Will you need repeat cortisone injections for shoulder arthritis?

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.  

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Modesto, CA 95355

Phone: (209) 524-4438

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