The shoulder is a ball-and-socket joint formed by the top of the upper arm bone (humeral head) and an extension of the shoulder blade (the glenoid). Covering the top of the humeral head and glenoid is a specialized tissue called articular cartilage. Cartilage does not have a blood supply, so when it is damaged or starts to break down, it does not grow back. The process of cartilage breakdown is called arthritis.
When cartilage loss starts to occur, inflammatory enzymes are released into the joint. These cause further breakdown until ultimately, the underlying bone is exposed. When bone rubs on bone, this causes significant pain and a sensation of cracking in the joint. Pain often leads to limited range of motion and weakness, which can lead to difficulties with activities of daily living and decreased quality of life. Once conservative treatment fails to meet a patient’s expectations for pain tolerance and function, a total shoulder replacement can be considered. This surgery can be very successful in alleviating pain and helping patients regain their quality of life.
- Generalized shoulder pain that feels like a deep ache
- Shoulder stiffness and decreased range of motion
- Shoulder weakness from lack of use or pain
- Pain that is worse at night
- Morning stiffness
- Audible cracking or popping upon movement
- Pain typically worsens over time
- Physical Therapy - A formal course of physical therapy (PT) is the first line of treatment. PT can help patients regain the strength and train muscles to compensate for the decreased range of motion.
- Injections - Steroid injections into the shoulder joint can be a very effective treatment to alleviate pain. When the pain subsides, range of motion frequently improves. The steroid can provide pain relief within one day. These injections can be repeated every three months if desired. If surgery is being considered, steroid injections should not be administered within three months of surgery due to an increased risk of infection.
- Anti-inflammatories - Nonsteroidal anti-inflammatory medications such, Ibuprofen or Aleve, can help decrease inflammation and pain caused by shoulder arthritis. This can be beneficial in addition to physical therapy, so patients can have less pain while regaining their motion and strength. Prescription-strength anti-inflammatory medications are occasionally prescribed if over-the-counter medications are not working.
- Surgery - For patients who have persistent pain/dysfunction after more conservative treatments, surgery to replace the shoulder can be considered.
Shoulder arthritis causes a deep ache in the shoulder joint that is often worse at night. Patients also frequently experience a cracking or grinding in the shoulder with movement that is called crepitus. The pain starts insidiously, which means it usually starts without any trauma or specific event. After taking a detailed history and a physical exam, x-rays will be obtained. This is a diagnosis that is usually made with x-rays, which show narrowing of the space between the bones that make up the shoulder joint and can show the bone rubbing on bone.
Conservative treatments are always recommended first. When patients have persistent pain/dysfunction that interferes with their quality of life and they have pain every day, surgery is recommended.
The most common risks are stiffness, persistent pain, and weakness. The arthritis will gradually worsen over time. As the pain progresses, range of motion typically gets worse and this leads to limited use and function of the arm that interferes with activities of daily living.