Arthritis is the inflammation of a joint. In the shoulder, it has the potential to occur at the glenohumeral (ball and socket), acromioclavicular (AC), or sternoclavicular joint (SC). As time goes on, the absence of the smooth covering on the ends of bones, also known as articular cartilage, brings forth pain and stiffness. This can lead to pain during movement or while at rest, as well as clicking or grinding sensations and a decline in strength. When the cartilage is damaged or reduced, the bones come into contact with each other during joint movement, resulting in what is known as "bone-on-bone" arthritis. In cases where arthritis becomes severe, inflammation arises around the joint and the body tries to protect the joint by forming extra bone, leading to restricted motion and strength.
Causes
Osteoarthritis, also referred to as degenerative joint disease, is the primary cause of arthritis. Degeneration of a joint, which causes pain and limited mobility, can occur due to various factors such as trauma, rheumatoid arthritis, systemic lupus, septic arthritis, and psoriasis.
Symptoms
Patients with arthritis in the glenohumeral joint (GH) may experience pain, stiffness, and a decrease in strength. They may also feel a sensation of "grinding," "clicking," or "locking" in the shoulder. The loss of range of motion can become severe, making it difficult for the patient to perform daily tasks such as putting objects on shelves or combing their hair.
In cases of AC joint arthritis, patients often notice a bump on the top of the joint. This bump can also extend downward on the inside of the shoulder and press against the top of the rotator cuff. As a result, AC joint arthritis can lead to symptoms of rotator cuff problems, including shoulder pain, pain at night, and difficulty lifting objects overhead.
Patients with SC joint arthritis may notice a painful bump above the joint. This swelling can develop rapidly and cause a visible deformity.
Diagnosis
Arthritis can be diagnosed by a physician through a physical examination and the review of X-rays.. When examining your shoulder, your orthopedic surgeon will assess its range of motion, strength, and any pain experienced during movement. Additionally, your surgeon may request further diagnostic tests, such as a CT scan or MRI, to thoroughly evaluate the bones, joints, muscles, tendons, and ligaments of your shoulder.
Treatment
Non-operative
Shoulder arthritis can be effectively managed through the use of physical therapy, which aims to strengthen the muscles that provide support to the joint. However, it is important to note that aggressive physical therapy is not recommended for individuals with advanced shoulder arthritis, as it has the potential to exacerbate symptoms. In such cases, your surgeon may opt to prescribe anti-inflammatory medication or administer an injection to alleviate inflammation. Additionally, incorporating certain nutritional supplements into your routine may prove beneficial in reducing both pain and inflammation.
Operative
In certain situations, surgery may be considered when non-operative treatment is unable to alleviate symptoms. Shoulder replacement surgery is the definitive treatment for Glenohumeral Joint (GH) arthritis. During this procedure, your surgeon will replace the worn-out cartilage with metal and plastic implants, resurfacing the ends of the bone.
The definitive treatment for alleviating the symptoms associated with AC joint arthritis is subacromial decompression and AC joint resection. These minimally-invasive arthroscopic procedures effectively eliminate bone spurs from in and around the joint, allowing for increased freedom of movement in the bones and alleviating any pressure that may be exerted on the rotator cuff muscles and tendons.
In the case of sternoclavicular arthritis, surgery is rarely necessary as non-operative treatment usually provides sufficient pain relief. However, if surgery becomes necessary, bone spurs from both bones in the joint will be removed by the surgeon to prevent the collarbone from rubbing against the sternum. This surgical intervention effectively eliminates pain and inflammation.
Sources
Senthelal S, Li J, Ardeshirzadeh S, et al. Arthritis. [Updated 2023 Jun 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518992/
https://my.clevelandclinic.org/health/diseases/22491-shoulder-arthritis
Pandey V, Madi S. Clinical Guidelines in the Management of Frozen Shoulder: An Update! Indian J Orthop. 2021 Feb 1;55(2):299-309. doi: 10.1007/s43465-0
Nazari G, MacDermid JC, Bryant D, Athwal GS. The effectiveness of surgical vs conservative interventions on pain and function in patients with shoulder impingement syndrome. A systematic review and meta-analysis. PLoS One. 2019 May 29;14(5):e0216961. doi: 10.1371/journal.pone.0216961.
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