Shoulder Arthritis

Shoulder Arthritis

What Is Shoulder Arthritis?

Shoulder arthritis is a joint condition in which the cartilage of the shoulder wears down or becomes inflamed over time, causing pain, stiffness and restricted movement. Cartilage is the smooth tissue that covers the ends of the bones forming the joint and allows pain-free movement; when it wears away, the bone surfaces work closer together and symptoms appear.

Shoulder arthritis is most often seen at an older age and can reduce quality of life over time with chronic pain, stiffness and loss of strength. In the early and middle stages many patients find relief with non-surgical measures. For other shoulder problems you can review the shoulder page.

Types and Affected Joints

Arthritis in the shoulder region can occur in two joints: the acromioclavicular (AC) joint between the collarbone and the acromion, and the glenohumeral joint between the upper arm bone and its socket. AC joint arthritis usually causes pain over the outer top of the shoulder, whereas glenohumeral arthritis causes deeper, more widespread shoulder pain. The type and location determine the symptoms and the treatment.

• Osteoarthritis: the most common type; the gradual breakdown of cartilage with age-related wear.
• Post-traumatic arthritis: develops after a fall, blow or shoulder injury, from the mechanical disruption in the joint even after the injury has healed.
• Inflammatory arthritis (such as rheumatoid): rheumatological diseases in which the immune system turns against the joint, often involving more than one joint, and treated together with rheumatology.

Symptoms

Symptoms usually begin insidiously and increase over time; the pain may be mild at times and appear as sudden flares in some patients. The location and nature of the pain can vary with which joint and which type of arthritis is involved.

• Chronic shoulder pain that increases with movement, and night pain in advanced stages.
• Stiffness and a reduced range of motion.
• Difficulty raising the arm and reaching behind the back, with limitation in daily movements such as dressing.
• A grinding sensation or noise with movement and, over time, loss of strength.

Conditions That Can Be Confused With It

Shoulder pain and stiffness look similar in many conditions; examination and imaging tell them apart. In frozen shoulder both active and passive movement are markedly restricted but the X-ray is usually normal, whereas in arthritis the joint space is narrowed on X-ray and bone changes are seen.

Impingement and tendon problems, which cause pain within a certain arc of movement without full stiffness, and AC joint arthritis over the outer top of the shoulder are also assessed separately. In pain referred from the neck, shoulder movement is free and the pain radiates down the arm. Making these distinctions correctly ensures treatment is directed at the right target.

Diagnosis: Examination and Imaging

Diagnosis begins with the history and physical examination; the range of motion, painful movements and grinding are assessed. Imaging clarifies the diagnosis and excludes other problems.

• X-ray: the basic study that shows narrowing of the joint space, loss of cartilage and bone changes.
• MRI: used when an accompanying soft-tissue problem such as a rotator cuff tear is suspected and for surgical planning.
• When inflammatory arthritis is suspected, a rheumatological assessment and blood tests may be requested.

Non-Surgical Treatment

The aim of treatment is to reduce pain, preserve movement and improve quality of life. Many patients, especially in the early and middle stages, find relief with non-surgical measures for a long time. The plan is individualised to the stage of the disease, the severity of symptoms and the patient's lifestyle.

• Activity modification and reducing the movements that provoke pain.
• Anti-inflammatory medication and cold application under medical advice for pain management; in inflammatory arthritis, disease-modifying treatments together with rheumatology.
• Physiotherapy: exercises that preserve range of motion and strengthen the surrounding muscles; an intra-articular injection in selected cases.

When Is Surgery Needed?

Surgery is considered in advanced stages where pain persists despite non-surgical treatment and clearly limits daily life. The method is chosen according to the stage of the disease and the state of the rotator cuff; general health is also assessed before surgery.

• Arthroscopy: in the early stage, cleaning damaged cartilage fragments and inflamed tissue can reduce pain; it does not eliminate the disease.
• Shoulder replacement: in advanced cartilage loss the damaged surfaces are replaced with an artificial joint, reducing pain and restoring function.
• Reverse shoulder replacement: preferred in selected cases where the rotator cuff is also severely deficient.

Recovery and Daily Life

After a replacement, physiotherapy aims to restore range of motion and strength gradually; recovery varies from person to person and progresses by criteria rather than a fixed calendar. Because replacements have a limited lifespan, joint-preserving methods are considered first in young and very active patients; the decision is made together with the patient's age, activity level and expectations.

Arthritis cannot be prevented entirely; however, habits that reduce the load on the joint, regular exercise and early treatment help ease symptoms and preserve function. Preserving the range of motion of the shoulder is important for keeping up daily activities for longer.

When Should You See a Doctor?

Having shoulder pain assessed early allows the correct type to be identified and appropriate treatment to be started in good time.

• Your shoulder pain has lasted for weeks, your range of motion is decreasing or night pain is breaking your sleep.
• Daily movements such as raising the arm, reaching behind the back and dressing are steadily becoming harder.
• There is swelling and pain in more than one joint or fever; this suggests inflammatory arthritis.

To have your shoulder symptoms assessed you can contact Assoc. Prof. Serkan Sürücü, and you can also review the other conditions covered within shoulder surgery.