Shoulder Arthritis: Treatment Options

Shoulder Arthritis: Treatment Options

Shoulder arthritis is the progressive loss of articular cartilage in the shoulder joint, also referred to as the glenohumeral joint. The severity of arthritis can range from a mild loss of cartilage all the way to a severe loss where bone is contacting bone.

Left untreated, it is hard to predict when and how fast arthritis will progress. In addition, the amount of arthritis seen on imaging does not always correlate with the severity of the patient's symptoms.

When treating shoulder arthritis, doctors will determine the treatment based on the patient's symptoms and how it is impacting their quality of life. If the arthritic process progresses, it can result in not only additional loss of cartilage but also damage to the underlying bone.

Nonoperative treatment of shoulder arthritis is based on controlling symptoms that the patient may be experiencing. These treatments may include activity modification and physical therapy exercises to help improve motion.

Over-the-counter nonsteroidal anti-inflammatory medications can be used to relieve pain along with the liberal use of ice, rest, and compression. Different types of injections are also an option and may help reduce inflammation.

In cases of mild osteoarthritis that is not responsive to nonoperative measures, surgical treatment may consist of an arthroscopic procedure where the surgeon uses a small camera and instruments to clean out the inside of a patient's shoulder to provide temporary relief. If the arthritis progresses, a shoulder replacement may be needed.

There are multiple types of shoulder replacements a doctor can perform based on several factors. A hemiarthroplasty may be performed. This is where the glenoid socket is left alone, but the round humeral head is replaced by a round metal component.

More commonly, the surgeon will perform either an anatomic shoulder replacement or a reverse shoulder replacement. In an anatomic shoulder replacement, the glenoid socket is replaced with an artificial socket made of either plastic or both metal and plastic, and the humeral head is also replaced with a metal ball attached to either a long stem or short stem, which extends into the upper arm.

With new technology, there are humeral head implants that do not require a stem into the upper arm that are available. It is important to note in an anatomic shoulder replacement, the orientation of the shoulder joint anatomy, a ball replaced by a ball and a socket by a socket is kept the same.

In a reverse shoulder replacement, the ball and socket that were used in the anatomic shoulder replacement now switch positions. The metal ball now sits on the glenoid socket, and a metal stem with a plastic cup now sits on the upper portion of the humerus.

There are several indications for a reverse shoulder replacement. These may include patients who have a massive rotator cuff tear that is not repairable with or without arthritis, fractures of the upper arm bone, and those who have had prior shoulder replacements that require additional surgery.

The changing construct allows for patients to use their large, powerful deltoid muscles to move their arm following surgery since they do not have a functional rotator cuff. After either surgery, the patient will first wear a sling to protect and support their shoulder.

They will perform simple motion exercises of their fingers, wrist, and elbow to prevent stiffness of these joints while in the sling. They will then slowly get their shoulder motion back with physical therapy. Strengthening exercises will then be introduced and over time, patients are able to return to their daily activities.