Shoulder arthritis

Shoulder Arthritis

What is it?

Osteoarthritis or “degenerative joint disease” is the most common type of arthritis about the shoulder. The other less commonly seen types of arthritis in the shoulder are rheumatoid or inflammatory arthritis and arthritis that occurs after severe trauma. In osteoarthritis the smooth cartilage that lines and coats the ends of the bones gets worn away causing the bone ends to rub against each other. This leads to irregular motion within the joint and the development of bone spurs. This can result in pain and loss of motion in the shoulder.  There are 2 joints within the shoulder that can be affected by osteoarthritis. The main joint which provides most of the shoulder motion is called the glenohumeral (G-H) joint which is where the humerus or arm bone meets the scapula or shoulder blade. The other smaller joint in the shoulder which does not provide much motion is the acromioclavicular (A-C) joint which is the joint that connects the collarbone and the scapula. 

Who gets it?

The incidence of shoulder arthritis increases with age. Generally it is seen in people over 50; however younger people can get it after suffering trauma to the shoulder such as a fracture or dislocation. Arthritis of the A-C joint tends to occur at a younger age than arthritis of the main joint of the shoulder the G-H joint. There is a genetic predisposition to arthritis so it can be hereditary as well.

What are the signs and symptoms?

The most common complaint of someone with shoulder arthritis is pain. The pain worsens with activities especially any overhead activities and decreases with rest. Arthritis of the G-H joint usually hurts mostly in the back of the shoulder while A-C arthritis hurts mostly in the front at the end of the collar bone. The next most common complaint is loss of motion which is much more severe in those with G-H arthritis. In addition, the motion of the shoulder can sometimes feel like grinding (crepitus) as the bones move in relation to one another. Fortunately not everyone who develops arthritis develops pain and loss of motion in fact some people with severe joint destruction have very few symptoms.

How is it diagnosed?

Arthritis of the shoulder is easily diagnosed with a physical examination and x-rays. On the physical examination the physician will be looking for pain on range of motion, crepitus or grinding of the joint, weakness of the shoulder and tenderness to touch.   X-rays of the shoulder show loss of joint spaces, bone cysts and bone spurs or osteophytes at the edges of the joint. People with arthritis of the A-C joint are also at risk for developing rotator cuff tears and an MRI may be needed.

How is it treated?

As with most other arthritic conditions, initial treatment consists of rest, activity modifications, therapy and anti-inflammatory medications such as ibuprophen. Icing and moist heat as well as other therapy modalities such as ultrasound may be prescribed. If these treatments do not work to decrease the symptoms then surgery may be suggested. For arthritis of the A-C joint this would involve removal of the end of the clavicle which can be done arthroscopically. For arthritis of the main shoulder joint, surgery usually involves a joint replacement operation where the arthritic surfaces of the bone are replaced with metal and plastic. Sometimes only a portion of the joint needs to be replaced (hemiarthroplasty).

 

Dr.  Jack Choueka is an Adult and Pediatric Upper Extremity Surgeon

and Chair of Orthopaedic Surgery at Maimonides Medical Center. 

Award winning hand surgeon Dr. Jack Choueka provides treatment for

all disorders of the upper extremity, including carpal tunnel syndrome,

arthritis, trauma, rotator cuff disease, and sports-related shoulder, elbow and wrist problems. He performs state-of-the-art surgery, including shoulder, elbow and wrist replacements. Dr. Choueka is a summa cum laude graduate from State University of New York Health Science Center’s Medical School; he completed his residency in Orthopaedic Surgery at the Hospital for Joint Diseases Orthopaedic Institute.

Dr. Choueka can be reached at 718-283-7400.