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Shoulder Arthritis - Overview
Arthritis in the shoulder is the third most common location for arthritis, following hip and the knee. The complex shoulder joint system allows us to be independent with our daily activities and complete incredible feats. When the shoulder becomes stiff and painful, it can severely affect your quality of life due to weakness and trouble elevating the arm overhead. Understanding what is shoulder arthritis, the symptoms, how to diagnose it, and the potential treatment options is the best way to manage your condition while minimizing loss of function.
What is Shoulder Arthritis?
Arthritis is defined as inflammation of a joint. This is caused by damage to the smooth cartilage within the joint, leading to symptoms of pain and stiffness. While there is no cure for arthritis, there are conservative treatment options for effectively managing symptoms and preventing unnecessary progression. If necessary, surgery is a possibility to help restore joint function and alleviate symptoms.
Where Shoulder Arthritis Occurs
Shoulder arthritis most commonly refers to the large ball and socket joint, also known as the glenohumeral joint. The ball of the joint is made by the upper arm bone (humerus) and the socket is made by the shoulder blade, also known as the glenoid fossa. Cartilage covers both sides of the joint to provide cushioning, with any of these areas being susceptible to damage.
A less common source of shoulder arthritis is caused by inflammation in the acromioclavicular joint (AC) joint where the shoulder blade and collarbone connect. This is more commonly referred to as AC joint arthritis.
Types of Arthritis that Affect the Shoulder
There are several different types of shoulder arthritis. Each type is caused by different mechanisms, which we will dive into below.
Osteoarthritis of the Shoulder
Osteoarthritis (OA) is known as damage to any joint related to wear and tear. Cartilage starts to degrade and can potentially wear down completely, leading to painful bone on bone grinding. It is the most common form of arthritis in the body. OA is associated with aging, throwing sports, previous injury, genetics, and overuse.
Rheumatoid Arthritis (RA) of the Shoulder
RA is an autoimmune disease that causes the body to attack its own tissues. This can affect the shoulder joints, leading to inflammation and breakdown of joint integrity. It can affect one or both shoulders at the same time since it’s systemic in nature. Causes of RA are largely unknown but have been correlated to genetics and lifestyle factors.
Post Traumatic Shoulder Arthritis
Trauma to the shoulder can result in long term complications with arthritis. This typically occurs over time due to underlying shoulder issues as a result of the injury. Trauma is caused by fracture, dislocation, or any other major injury to the shoulder.
Avascular Necrosis
Necrosis, or osteonecrosis, refers to loss of blood flow to a bony area that results in tissue death. In the shoulder, it can affect the head of the humerus (the “ball” of the joint). Loss of blood supply is often the result of trauma or other injury to the shoulder.
Rotator Cuff Arthropathy
Arthropathy refers to a severe tear of one or more of the four tendons in the rotator cuff. Since the rotator cuff provides secondary stability to the shoulder, a major tear can lead to a compromise of shoulder mechanics and onset of arthritis.
Symptoms of Arthritis in the Shoulder
Each person responds differently to arthritis. The severity of symptoms ultimately depends on the extent of the cartilage damage.
What Does Shoulder Arthritis Feel Like?
Symptoms and severity of shoulder arthritis will vary from person to person. General shoulder pain and stiffness are the most common signs. The pain tends to be more achy in nature and gets worse with shoulder use. If your shoulder pain is sharp, is most profound with sleep, or is accompanied by neurological symptoms such as tingling, numbness, or shooting pain into the arm, there may be other issues going on within the neck or rotator cuff and your doctor should be contacted immediately.
Most Common Symptoms
However, other factors such as general health, pain beliefs, lifestyle factors, and upper body strength and mechanics can all play a role. There are three primary symptoms for shoulder arthritis.
Pain in the Shoulder
This is the most common symptom of arthritis. It might be present in the front, back, or side of the shoulder. Typically, pain is aggravated with activity such as lifting and reaching. However, some people experience pain when the arm is at rest too. If severe enough, occasionally the pain can radiate down the arm or even into the wrist and hand.
Stiffness in the Joint
With time and increasing shoulder pain, most people will start to notice a gradual loss of range of motion as the shoulder becomes stiffer and stiffer. This can lead to loss of shoulder function for your normal daily activities.
Grinding and Clicking
Since the cartilage within the shoulder is no longer smooth, it can lead to poor shoulder mechanics. Bone spurs can also be present within the joint. Thus, sensations of grinding or clicking (also known as crepitus) are common with arm use. The shoulder might also feel “locked” or cause a feeling of shifting within the joint with certain movements.
Diagnosing Shoulder Arthritis
Arthritis of the shoulder is most often diagnosed with a physical exam. Your doctor will assess your history, strength, range of motion, and palpate for sources of pain. If necessary, your doctor may order an x-ray or CT scan to confirm or assess the severity of arthritis. To rule out other conditions like a rotator cuff tear, your doctor may also order an MRI.
The Next Steps
Getting a shoulder arthritis diagnosis can feel defeating since there is technically no cure. However, with the right understanding and treatment you can manage and prevent progression of symptoms. Your doctor can help you decide which options are best for you.
Effective pain relief and best treatment options include lifestyle modifications and pain management with anti-inflammatory medication (NSAIDs), ice, heat, TENs, and massage. Physical therapy is one of the best conservative nonsurgical treatment options you should consider. Lastly, more invasive treatment options are available such as corticosteroid injections and surgery, including an arthroplasty or total shoulder joint replacement.
Sources:
https://www.hss.edu/conditions_shoulder-arthritis-overview.asp
https://www.hopkinsmedicine.org/health/conditions-and-diseases/shoulder-arthritis
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