What is Shoulder arthritis?
Shoulder is one of the most mobile joints in our body. It is a ball and socket joint between humerus (upper arm bone) forming the ball and the glenoid (shoulder blade) forming the socket. . It can be caused by degenerative wear and tear due to ageing (osteoarthritis), rheumatoid arthritis (inflammatory) and after an injury (post-traumatic) like a broken shoulder or a torn ligament/tendon and rotator cuff tear arthropathy. Osteoarthritis mostly affects adults above 60 years. Rheumatoid arthritis commonly affects women in the age between 20-40 years.
What are the symptoms of Shoulder arthritis?
Most patients with shoulder arthritis presents with pain, swelling, stiffness and deformity. The symptoms could be variable and is usually depends on severity of arthritis and level of activity of the affected person. Persistent stiffness could lead to weakness and in advanced stages the joint could sublux leading to the deformity. A grinding, cracking or clicking sound is also audible with the movement of the shoulder and in some patients the pain could wake them up from sleep. You feel difficulty in performing overhead activities like combing your hair or reaching to an overhead shelf. Snapping, grinding or clicking sound can also be heard with every movement if the shoulder. Night pain and disturbed sleep become common as the disease progresses.
If you have affections of AC joint, then pain is felt towards the top of the shoulder that may extend to the side of the neck.
How is it diagnosed?
Your orthopaedic surgeon will confirm its diagnosis by evaluating your complete medical history, physical examination, and X-ray. Your surgeon will also ask for scans (USS, CT, MRI) and blood tests.
What happens if nothing is done?
If shoulder arthritis is left untreated, the range of motion becomes more limited with progressing arthritis. Marked disability with constant pain and stiffness develops hindering the normal activities of daily life. It becomes very difficult to manage pain with painkillers in such cases.
How is it treated?
Arthritis is not curable. However, its symptoms can be reduced by a number of treatments. It can be managed surgically and non-surgically. Non-surgical treatment options involve activity modification, rest, painkillers, anti-inflammatory medicines, warm or cold therapy, steroid injection and physiotherapy.
Surgery is indicated in-
- Failure of conservative treatment
- Advanced arthritis
- Severe pain
- Unstable joint
- Joint subluxation/dislocation
- Patient preference
- Rotator cuff tear
- Prolonged disability
- Persistent pain
- Avascular necrosis
What are the non-operative treatments?
Non-operative treatment is the first line of treatment for shoulder arthritis. It includes the following ways-
- Rest- rest and modification of activities is advised to the patient to relieve pain and avoid any activity that can trigger pain.
- Icepacks or moist heat- ice-packs or moist heat is applied to the affected joint in order to relieve pain and swelling of the joint for 20-30 minutes twice or thrice a day.
- Physiotherapy- it is recommended to prevent the stiffness and restore the lost range of motion.
- Medicines- painkillers like paracetamol or codeine and anti-inflammatory medicines like aspirin or ibuprofen are given to the patient to manage pain and inflammation. However, they can just relieve the symptoms but cannot cure the condition completely.
- Steroid injection– steroid injection (cortisone) in the affected joint relieves pain. However, it usually provides temporary relief of pain and inflammation of the shoulder.
- Dietary supplements – glucosamine and chondroitin sulfate can be taken to reduce pain but there is less evidence to support their efficacy in arthritis. However, it should be taken after the consultation with your physician as it may interact negatively with medicines.
What does the operation involve?
The main aim of the surgery is to provide long-term relief from the pain and restore the normal range of function of the shoulder joint. It is chosen when conservative methods fail to relieve pain. Arthroscopy and shoulder arthroplasty (shoulder joint replacement) are the techniques that can be used to treat shoulder arthritis.
- The arthroscopy is conducted as a day case under general anaesthesia and small cuts or big cut is made on the affected site, according to the surgery selected.
- In arthroscopy, the damaged portion of the bone i.e. cartilage or bony spurs is removed with the help of a tiny camera and small thin instruments. In arthroplasty, your surgeon will remove the damaged joint and will fit an artificial joint. The artificial socket is prepared from plastic and is connected to the bone with special synthetic cement. The ball is made of cobalt-chromium alloy.
- The skin is closed by absorbable sutures. The whole operation ends in 1-2 hours and most patients are discharged the same day.
What happens after surgery?
- The local anaesthetic wears off in 4 to 12 hours after surgery. Patients are given painkillers before the pain starts i.e. on return to home. It is continued for at least 48 hours after the first dose. Thus, most of our patients report little pain.
- You may be discharged from the hospital same day if you had arthroscopy vs 2 to 3 days as shoulder replacement is a major surgery.
- Before discharge, your physiotherapist will teach you gentle exercises of fingers, wrist, elbow and pendulum exercises for the shoulder. This is necessary to prevent stiffness, pain and to maintain the strength of the muscles near your shoulder after healing.
- A shoulder sling is applied on your operated shoulder to provide support and avoid new injury to this area.
- You are reviewed after two weeks of surgery to check the status of the wound and the shoulder joint.
- The wound should be massaged (typically after 2 weeks) using the moisturizing cream by the patient 3 times a day for 3 months once the wound is well healed. This reduces the scar sensitivity and scar-related complications (tenderness; helps scar to mature).
- Physical therapy is advised to facilitate rehabilitation. The physical therapy begins with gentle exercises and progressed to more aggressive exercises at about 8 weeks of surgery. This will be guided by your surgeon and is based on radiographic (X-ray) and clinical assessment. It is advisable to avoid any injury to the affected area for 3 months. The duration may increase or decrease based on the severity of the problem and treatment involved.
Are there any risks?
- Persistent pain
- Frozen shoulder
- Injury to nerves Axillary and Brachial plexus
- Damage to the blood vessel
- Loosening or dislocation of the artificial replacements
- Rotator cuff tear
- Stiffness/frozen shoulder
- Allergic reaction – your body may react against artificial components and produce allergic reactions.
- Implant problems– wearing of the implant may happen and the components may get loosened. This calls for their replacement and you may require additional surgery if the implant break or wears down excessively.
- Implants usually last for 10-20 years, however gives a good quality of life during that period. Patients will need a revision replacement after that time, the risks associated with revision surgery are more.
- Thrombosis and blood clots
What are the results of the operation?
Most patients report great relief of pain and restoration of good function of the shoulder after surgery. The outcome of the operation is more predictable in the author’s experience.
When can I return to driving and work?
You can return to work in 1- 2 weeks and resume driving in 1-2 weeks after the arthroscopy and 4-6 weeks after arthoplasty. Immobilization/restrictions in movements usually ends in 6 weeks after the surgery, after this, you can get back to your normal activities. However, it may take another 6-12months to achieve full recovery. Your surgeon can give you the correct estimation.
- Arthritis in a young patient with good bone stock – Total Shoulder Replacement with an stemless implant
- Arthritis in an older patient with poor bone stock – Total Shoulder Replacement with an stemmed implant
- Arthritis in an older patient with long standing rotator cuff tear – Reverse Polarity Total Shoulder Replacement.