Shoulder Arthritis - Types, Clinical Features, Diagnosis, and Treatment

What Is Shoulder Arthritis?

Arthritis is the inflammation of one or more joints. Osteoarthritis (a type of shoulder arthritis) is a condition that destroys the smooth outer covering (articular cartilage) of bone. Therefore, it becomes frayed and rough, and the protective space between the bones decreases. Thus, the cartilage surrounding the joints of the bones wears away, resulting in friction between the bones, which is often referred to as bone on bone.

The shoulder joint is called the bigger ball and socket joint, the glenohumeral joint. The cartilage covers both the ball (the humeral head) and the socket (the glenoid). Shoulder arthritis is characterized by the destruction of the superficial and deep layers of the cartilage surrounding the shoulder joint.

What Is the Pathophysiology of Shoulder Arthritis?

Normally, the joints in the body are covered by cartilage to provide smooth contact between bones and to aid in a gliding motion. In the case of arthritis, the cartilage wears away, resulting in direct bone-to-bone contact. The pathophysiology of shoulder arthritis is explained below:

• The cartilage that covers the joints undergoes wear and tear.
• The surface of the cartilage becomes irregular.
• Cartilage gradually becomes thin, thus exposing the surface of the bone.
• Severe pain might occur due to rubbing two bones against each other.

Who Is Prone to Developing Shoulder Arthritis?

Shoulder arthritis is more prevalent in individuals over the age of 50 and can occur in younger individuals with rheumatoid arthritis or following shoulder trauma, such as dislocation, broken shoulder bones, or infection.

What Are the Types of Shoulder Arthritis?

There are several types of shoulder arthritis. Each type has its characteristics; however, the exact cause remains unknown.

• Osteoarthritis - Also known as degenerative arthritis. This is the most common form of arthritis and can also affect other joints besides the shoulder. It is most commonly linked to age-related wear and tears.
• Rheumatoid Arthritis - It is an autoimmune disorder, which means the immune system attacks the body’s healthy cells and tissues (even the joints of the body). Studies show that rheumatoid arthritis may affect both sides of the shoulder.
• Post-traumatic Arthritis - If the shoulder is fractured, dislocated, or injured, post-traumatic arthritis may develop.
• Rotator Cuff Tear Arthropathy - Can develop after a prolonged and massive rotator cuff tear.
• Shoulder Arthritis Due to Avascular Necrosis - Occurs due to disrupted blood supply to an area of the body, which results in necrosis.

What Are the Sensations or Symptoms Associated With Shoulder Arthritis?

If an individual has shoulder arthritis, they will experience pain and stiffness in the shoulder, which can range from mild to severe. As time goes on, they will likely notice a reduction in the shoulder's range of motion, particularly if the glenohumeral joint is affected. Individuals might feel pain when reaching overhead, lifting heavy objects, or participating in activities that require various arm movements. In the later stages of the condition, even simple everyday tasks such as grooming, bathing, and using the computer or writing can become painful.

How Is Shoulder Arthritis Diagnosed?

The doctor will find out the cause of your pain, a detailed medical history, and a physical examination will be done for evaluation. Tenderness and swelling are checked, and the range of motion is also evaluated.

• Blood Tests - The blood examination does not aid in diagnosing shoulder arthritis. However, it shows a rise in erythrocyte sedimentation rate (ESR), indicating inflammation.
• X-rays - The specialist may order an X-ray to visualize the space between the shoulder joints. The excessive loss of cartilage is determined by the closer contact between the bones.
• Magnetic Resonance Imaging (MRI) - MRI helps examine the soft tissues around the shoulder joint.
• Computed Tomography (CT) - It is usually preferred to evaluate the bony structures of the shoulder joint.

What Are the Complications of Shoulder Arthritis?

• It can worsen with time and eventually cause loss of range of motion, making it difficult to lift the arm.
• People with osteoarthritis and inflammatory shoulder arthritis find it difficult to perform daily activities.

How to Treat Shoulder Arthritis?

Physical Therapy: Physical therapy is essential in maintaining or improving the range of motion and reducing the shoulder joint’s burden through:

• Stretching exercises.
• Strengthening exercises.
• Activities that put stress on the joints and arms should be prevented. Shoulder exercise can be beneficial if the shoulder is weak.
• Moist heat may make the arms feel more comfortable.
• Icing the shoulder may reduce inflammation.
• Avoid lifting heavy objects.
• Limit activities that increase shoulder pain.

Medications:

• NSAIDs (Non-steroidal Anti-inflammatory Drugs) - Relieves the pain.
• Corticosteroids - These are used to prevent inflammation in the joint and minimize the symptoms and pain.
• Injection of Viscosupplementation - Injected in the joints to increase the lubrication of joints.
• Dietary Supplements: Foods rich in vitamins A, D, C, E, and K and antioxidants help reduce the symptoms of shoulder arthritis.

Surgical Management:

• Shoulder Arthroscopy - This is a minimally invasive surgery and may be helpful for symptoms of shoulder arthritis.
• Shoulder Replacement Surgery - This can be an option for the relief of pain in severe shoulder arthritis.
• Reverse Shoulder Replacement - This reverse technique allows for better function when there is a non-functioning rotator cuff.
• Resection Arthroplasty - A surgical procedure that involves the removal of a minor amount of bone at the end of the clavicle (collarbone). Gradually, scar tissue fills up the space between the shoulder and the clavicle.

Are Glucosamine or Chondroitin Effective Supplements for Treating Shoulder Arthritis?

Some individuals with arthritis report that glucosamine and chondroitin alleviate their joint pain. However, these personal accounts are difficult to assess. The Food and Drug Administration does not regulate supplements, and unlike medications, there is limited scientific evidence to support the effectiveness of supplements in treating arthritis.

Always consult the healthcare provider before taking these or any other herbal products, supplements, or over-the-counter medications. They can provide informed advice and ensure these products do not interfere with the current medications.

How Can Shoulder Arthritis Be Prevented?

Shoulder arthritis may occur due to various factors. Therefore, it is not possible to completely prevent it. However, the risk of developing it may be reduced by:

• Proper weight management.

• Avoid activities that may cause shoulder injury.

• Choose low-impact exercises.

• Eat nutritious foods such as fatty fish, green leafy vegetables, berries, nuts, etc.

What Can an Individual Expect as an Outcome if They Have Shoulder Arthritis?

The outcome depends on factors such as activity level, age, and the types and range of movements they perform with their arm and shoulder. Additionally, the size, location, and severity of the shoulder arthritis play a significant role. Since each individual's situation is unique, consult the healthcare provider to understand the expected outcome and to explore all available treatment options.

Conclusion:

The specialist mainly focuses on minimizing pain, preventing disease progression, and controlling symptoms of shoulder arthritis. In addition, the preservation of joint function and the reduction of the severity of the disease are also essential. Early treatment and diagnosis may be able to prevent tissue damage caused by arthritis. However, the severe forms may be long-lasting, and one can survive them with proper management.