This website is under development - The information contained on this site is for guidance only and is not intended for self diagnosis or self treatment. This will not replace professional medical advice or consultation. Always seek the professional advice of a qualified health care provider like your doctor or specialist before embarking on any treatment. If you have a problem please consult your doctor or specialist.
What is it?
The main shoulder joint is the joint between the shoulder blade (socket - glenoid) and the top of the arm bone (ball - humeral head). Arthritis of shoulder refers to wear and tear that occurs in the lining structure of the main shoulder joint. When the low friction cartilage liner that coats the ball and the socket becomes thin or even completely lost, then one has developed arthritis. In essence, the low friction essentially nerve ending free interface has disappeared exposing a high friction interface with nerves.
Despite popular belief, that arthritis does not develop overnight, it is a slow process going through various stages and becomes symptomatic with time.
Symptoms of arthritis depends upon the stage it has reached. In the early stages the symptoms are quite vague and may be very difficult to distinguish from other shoulder conditions. Although age can be a clue, I have seen advanced arthritis in someone as young as 35.
In the early stages, arthritis can give rise to symptoms like pain, activity related fatigues, “catching sensation” or intermittent decreased range of movement. There may also be weakness due to pain inhibition of the muscles. Pain is typically felt around the shoulder or over the insertion of the deltoid muscles. Night pain is also typical. Other symptoms described in the impingement syndrome section like pain along biceps muscles, pins & needle sensation in the forearm and hand can also occur. Therefore, early arthritis is a challenging condition to diagnosis based purely on history and clinical examination.
When the arthritis becomes more advanced, it is easier to diagnose. Advanced arthritis is typified by the classic “striction-friction grating”. In addition, one has restricted range of movement especially of rotational movements, clicks & clunks from the joint movement, pain on initiation of movements, night pain and sleep disturbances.
There is no cure for arthritis; but which I mean the condition cannot be reversed. Depending upon the stage of the arthritis, one can slow down the inevitable deterioration or provide symptomatic treatment. In advanced stages shoulder replacement can be done.
In the early stages, activity modification including avoiding loading the shoulder joint, simple analgesics, judicious and intermittent use of anti-inflammatory agents may all help. Off-loading shoulder joint by doing appropriate exercises may also help. There is some weak evidence to support the use of glucosamine and chondroitin sulphate tablets.
In slightly more advanced stage options include one or two intra-articular long acting steroid injection, arthroscopic washout, arthroscopic rotator interval release with or without biceps tenotomy and very occasionally micro-fracture of the bare intra-artricular bones can be done. Success rates are variable and is depends on number of factors.
In advanced arthritis, joint replacement is the only way to give symptom relief. Depending on the age of the patient, their mind set and their expectation, the options include surface replacement hemiarthroplasty, conventional hemiarthroplasty or total shoulder replacement.
In advanced arthritis and long standing rotator cuff tear with decentralised humeral head and pseudoparalysis, the only surgical option to consider reverse shoulder replacement.