Shoulder arthritis is a common source of chronic shoulder pain and shoulder disability that affects more than 20% of the older population. There are 2 distinct joints in the shoulder area that can be affected by arthritis—the AC joint (acromioclavicular), which is where the collarbone (clavicle) meets the tip of the shoulder bone; and the glenohumeral joint where the upper arm bone (humerus) meets the shoulder blade (scapula). Damage to the cartilage surfaces is usually the primary cause of shoulder arthritis.

Major Types of Shoulder Arthritis

  • Osteoarthritis: This degenerative shoulder condition is commonly referred to as “wear-and-tear” arthritis because the smooth outer coverage (articular cartilage) is essentially destroyed. Osteoarthritis usually affects people over 50 years of age and is very common in the AC shoulder joint (although it is not always symptomatic) and fairly common in the glenohumeral joint.
  • Rheumatoid Arthritis: This arthritis can affect a person of any age and usually affects multiple joints on both sides of the body. For example, in addition to affecting the shoulder, the knee and ankle might also show signs and symptoms of rheumatoid arthritis. Rheumatoid arthritis is an autoimmune, inflammatory condition of the joint lining.
  • Post-Traumatic Arthritis: Post-traumatic arthritis is a form of osteoarthritis that develops after an injury, such as a fracture or dislocation of the shoulder. This type of arthritis can also develop in the glenohumeral joint after a chronic rotator cuff tear.

Symptoms

Both image demonstrate loose bodies within the glenohumeral joint that are most commonly found in shoulders with degenerative osteoarthritis and/or chonderal defects.

The most common symptom associated with arthritis of the shoulder is pain. Arthritis-related shoulder pain can range from instances of long, mild pain, to periods of intense, sharp shoulder pain. The pain is almost always intensified and aggravated by activity and progressively worsens.

Depending on what joint is affected by arthritis, the pain may be felt in the center of the back of the shoulder (if the glenohumeral shoulder joint is affected), whereas pain will typically be focused on the top or front of the shoulder if the arthritis is in the AC joint. Patients with rheumatoid arthritis will have pain in both areas and a change in weather will usually intensify the discomfort.

Limited range of motion or stiffness and difficulty lifting, reaching or stretching the arm can also be symptoms of shoulder arthritis. Mechanical symptoms such as clicking, snapping, or popping can also be present. As the disease progresses, any movement of the shoulder causes pain. Night pain is common and sleeping may be difficult.

Treatment

Non-Surgical

There are many treatment options for shoulder arthritis. Many patients can live with the symptoms for years and will only need to take pain medications such as anti-inflammatory drugs and receive cortisone shots to help relieve shoulder arthritis symptoms. Physical therapy exercises also help to preserve motion and strength. For others who experience chronic shoulder arthritis symptoms and whose shoulder arthritis continues to worsen, surgery is available.

Surgical

Both images are good examples of large osteophytes on the inferior aspect of the humeral head that would be removed during the CAM procedure. Large osteophytes have been shown to impinge upon the axillary nerve which can be a source of pain in those with osteoarthritis.

Treatment decisions are based upon the cause, the intensity of the symptoms, and the severity of the patient’s disease. Each year, over 25,000 shoulder replacement surgeries are performed in the United States to relieve pain and improve function for shoulders that are severely damaged by glenohumeral arthritis.  Read about one of Dr. Millett’s patients who underwent shoulder replacement surgery for arthritis.

Arthritis in the very early stages can be controlled and treated with arthroscopic techniques. During this procedure, Dr. Millett will trim out the inflamed synovial lining tissue and remove pieces and fragments of degenerated cartilage. Arthroscopic treatment for shoulder arthritis will not cure the arthritic condition, but it will prolong more drastic measures and relieve many symptoms for a while.

The left arthroscopic image showing the axillary nerve with surrounding scar tissue in a patient with degenerative osteoarthritis. Axillary neurolysis (relief of nerve entrapment from scar tissue) is one aspect of the CAM procedure that is thought to decrease pain and improve shoulder function. The right arthroscopic image shows the removal of scar tissue surrounding the axillary nerve.

In more severe shoulder arthritis conditions, Dr. Millett has developed a new joint preservation procedure called the CAM procedure. CAM is an acronym for Comprehensive Arthroscopic Management, which is a very precise combination of surgical procedures that is aimed at treating all the major pain generators. The CAM procedure can be performed in young, active patients with arthritis who wish to preserve their shoulder joints or in older patients who wish to avoid joint replacement surgery. Although minimally invasive, it is very technically demanding and is not performed widely at other centers. Nevertheless, the clinical results have shown decreased pain, improved function, and good durability, without the need for total joint replacement.

When the arthritis is end-stage or in other instances where the joint can no longer be salvaged, joint replacement surgery may be the best option. Joint replacements, also known as total shoulders, have been around for many years and Dr. Millett has literally performed several hundred of these procedures.

The top image is a chondral defect that subsequently underwent a microfracture procedure. Both bottom images are good examples of the microfracture technique used for isolated chondral defects. The defect margins are debrided, the calcified layer is removed and small holes are made in the subchondral plate 3-4 mm apart and approximately 4 mm deep. The purpose is to allow bone marrow elements to emanate from the holes to form a “superclot” within the chondral defect. Stem cells then mature into fibrocartilage which fills the chondral defect over time.

Shoulder replacement surgeries are among Dr. Millett’s favorite procedures to perform because the results are so predictable and the pain relief is so complete. Shoulder replacement surgery is highly effective at eliminating pain and restoring function so that patients can return to activities of daily living and sports such as skiing, tennis, and golf. During these procedures, the joint surfaces are surgically replaced through an incision in the front of the shoulder, and a metal ball and plastic socket are inserted to resurface the damaged joint surfaces. Only one muscle is split during the procedure. Full recovery with return to unrestricted activities can be expected by 3 to 4 months.

Before a treatment plan can be put into place, Dr. Millett will need to examine your shoulder and review various imaging studies such as X-ray’s and MRI’s to determine the cause of the shoulder arthritis and the stage it is so he can discuss the various treatment options with you and help develop the best course of treatment given your particular circumstances and goals.

This x-ray image shows a total shoulder arthroplasty in a patient with severe degenerative osteoarthritis.

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