Arthritis of the Shoulder
Arthritis is a condition that occurs in various joints in
the body, especially in the knees, hips, and spine. It can
affect any joint, but the shoulder is affected infrequently.
When arthritis occurs, the cartilage that covers the ends of
the bones making up the joint breaks down and often flakes
off into the joint. The joint becomes swollen and stiff, and
the lining tissue of the joint (the synovium) becomes
overgrown. Frequently, spurs will develop around the margins
of the joint and can, sometimes, break off inside. The pain
can vary from mild to very severe, depending upon many
factors, including the severity of the disease, the type of
arthritis (most are wear and tear, or degenerative
arthritis, but some are caused by rheumatoid disease) and
the activity level.
Who usually gets arthritis?
Anyone can develop arthritis, but it most often occurs in
middle aged patients and senior citizens. The condition may
occur spontaneously or as a late result of previous trauma,
such as fracture or dislocation. It also may occur as a
result of an inflammatory disease such as rheumatoid
CAUSE - Three major types of arthritis generally
affect the shoulder.
- Osteoarthritis - Osteoarthritis, or
"wear-and-tear" arthritis, is a degenerative condition
that destroys the smooth outer covering (articular
cartilage) of bone. It usually affects people over 50
years of age and is more common in the acromioclavicular
joint than in the glenohumeral shoulder joint.
- Rheumatoid Arthritis - Rheumatoid arthritis
is a systemic inflammatory condition of the joint
lining, or synovium. It can affect people of any age and
usually affects multiple joints on both sides of the
- Posttraumatic Arthritis - Posttraumatic
arthritis is a form of osteoarthritis that develops
after an injury, such as a fracture or dislocation of
the shoulder. Arthritis can also develop after a rotator
How do I know if I have arthritis?
The shoulder joint becomes stiff, feels heavy, and
fatigues easily when arthritis is present. The stiffness is
usually worse in the morning, and can slowly improve with
"warm up activities." Also, grinding and catching in the
shoulder is a common sign of arthritis.
DIAGNOSIS - A physical examination and X-rays are
needed to properly diagnose arthritis of the shoulder.
During the physical examination, your physician will look
- Weakness (atrophy) in the muscles
- Tenderness to touch
- Extent of passive (assisted) and active
(self-directed) range of motion
- Any signs of injury to the muscles, tendons, and
ligaments surrounding the joint
- Signs of previous injuries
- Involvement of other joints (an indication of
- Crepitus (a grating sensation inside the joint) with
- Pain when pressure is placed on the joint
- X-rays of an arthritic shoulder will show a
narrowing of the joint space, changes in the bone, and
the formation of bone spurs (osteophytes).
If an injection of a local anesthetic into the joint
temporarily relieves the pain, the diagnosis is supported.
TREATMENT - Treatment begins with conservative
measures including anti-inflammatory medications, rest, ice,
and physical therapy. Injections of cortisone can be
therapeutic. If conservative options arenít effective,
surgery can be beneficial. The definitive treatment for
advanced arthritis of the shoulder joint is a total shoulder
The surgery involves replacing the worn-down humeral head
with a metal ball and the glenoid with a polyethylene
socket. By three months after surgery, patients usually have
significantly less pain and their motion is about half
PREPARATION - Except for emergency reasons, your
surgery will be scheduled in advance. Knowing the date of
your operation, you will have enough time to prepare and
plan for any special help you might need following discharge
from the hospital. The average length of stay in the
hospital for a total shoulder replacement is two to three
It is important to have a partner to assist you with your
home exercises following discharge. Your partner should
accompany you to physical therapy at least once or twice
during your hospital stay.
You should discontinue use of any anti-inflammatory
medication, including aspirin, one week before surgery.
Check with your doctor before discontinuing use of any
A series of pre-operative tests will be scheduled one to
two weeks before surgery. They will usually include: blood
tests, an electrocardiogram (EKG) or test that records
electrical activity of the muscle, a physical examination, a
visit with your orthopedic surgeon and anesthesiologist (the
physician that will administer pain medication during the
procedure). You will receive your routing schedule by mail.
Most patients spend the night before surgery either at
home or in a hotel nearby. They are then admitted to the
hospital the next morning. This method of admission is
called TCI - "to come in." This allows you to be with your
family the night before your surgery. Your surgeon will
inform you of your scheduled surgery appointment time and
where to go to within the hospital on the day of the