Arthritis of the Shoulder Joint

Introduction

The term "arthritis" is usually used to mean the progressive loss of the cartilage lining of any joint.The cartilage acts as a shock absorber and contains no nerves.This,in turn,means that when the cartilage has worn away,the bone(which has abundant nerves) underneath is exposed resulting in pain.This causes the person to use that joint less and less resulting in stiffness

Causes

In most cases there is no known cause and is simply due to “wear and tear” as one gets older.This is also called primary arthritis.Secondary arthritis occurs as a direct result of some other disorder eg gout,fractures and large rotator cuff tears.In South Africa,osteoarthritis is very much more common than Rheumatoid arthritis.

Symptoms

The most common complaint is pain and occasionally stiffness.Sleeping on the affected shoulder is usually very difficult,as is doing every day activities such as washing hair and reaching behind your back.Very common there is a family history of arthritis,and arthritis of some other joint is often present at the initial consultation.

Making the diagnosis

Any person over the age of 45 with a long history of pain and stiffness,must be suspected of having arthritis.Shoulder examination is often much less convincing than the symptoms,but there is usually a decrease in all movements accompanied by mild to moderate pain.The diagnosis is usually made on X-ray,but can also be picked up on ultrasound.

Treatment

There are 4 ways of treating arthritis:

Anti-inflammatory medication only
Injection of cortisone and anaesthetic into the joint
Arthroscopic washout of the joint,combined with release of the joint capsule
Replacement of half(hemiarthroplasy)or the whole joint(Total Shoulder Replacement)

Note

In general this treatment protocol is applied from numbers one to four in patients under 50 with milder forms of arthritis.In older patients with advanced disease,a Total Shoulder Replacement is the treatment of choice.The golden rule of joint replacement anywhere in the body,is to try and manage the arthritis conservatively for as long as is comfortably possible BEFORE resorting to replacing the joint,as this operation has a finite life-span(10-15 years).

Go back to conditions