Dear Dr. Millett,

Just how common is shoulder arthritis among adults under the age of 50?

Thanks,
Carl A.

Dear Carl,

While it is more common for arthritis to affect adults over the age of 50, we are seeing more and more young patients with loss of cartilage and joint destruction (arthritis). Many of these patients have lead very active lives that have resulted in traumatic injuries to the shoulder, overuse problems to the shoulder, or prior surgery to the shoulder. Adults under 50 who suffer from arthritis of the shoulder are typically very active and often are former athletes. While traumatic injuries such as dislocations can be a common cause of premature arthritis, it can also be the result of overuse of the shoulder from work or sports. Overuse injuries are caused by a repetitive motion that stress the cartilage, muscles, tendons, and bones of the shoulder. Because of the lack of recovery time between injuries the shoulder does not heal properly and arthritis sets in. Athletes most likely to suffer from shoulder arthritis include baseball players, swimmers, quarterbacks, and golfers, but many other types of sports can also lead to shoulder arthritis if played excessively over the course of time or if there was a traumatic event.

It’s important to note that the early symptoms of shoulder arthritis can appear in young adulthood, although in many cases an individual may not even realize it. The best way to avoid arthritis of the shoulder is to obtain an adequate amount of rest and appropriate rehabilitation when an injury occurs. Appropriate treatment of acute injuries can be a key to prevent shoulder arthritis later in life.

When arthritis of the shoulder does occur, it is typically one of two types: (1) it is either osteoarthritis, which is the result of wear and tear that occurs as joints break down, or (2) it is post-traumatic arthritis, which is the result of a specific joint injury, such as a fracture that leads to accelerated and progressive joint destruction. Typical symptoms are pain and stiffness. Weakness is a secondary factor that sets in and muscle atrophy can occur because of lack of use.

Treatments are generally targeted at restoring mobility and recreating smooth joint surface. Non-surgical treatments include anti-inflammatory medication, injections, and physical therapy. When this fails, arthroscopic surgery can be helpful to restore mobility and alleviate pain. When the joint destruction is severe total shoulder replacement with an artificial metal and plastic shoulder prosthesis (implants) may be needed.

While a total shoulder replacement can be very effective for pain relief and for restoring function, the problem is durability of the implants as the total shoulder replacement will not typically last as long in young people due to their higher functional demands and activity levels. Because of this, I am particularly interested in finding novel solution for this patient population and have been doing research in this area. In some cases, we can use arthroscopic surgery and a procedure called a microfracture procedure to rebuild the lost cartilage. For those who are really active and otherwise would be candidates for total shoulder replacement because they have advanced cartilage loss and joint destruction, I have developed a specific procedure called a CAM procedure – for Comprehensive Arthroscopic Management. This procedure can be used in active patients who desire a joint preserving approach. In this procedure we re-shape the humerus (ball) making it round again, remove compressive bone spurs from the nerves that cross the shoulder, and release scarring in the capsule to restore mobility and decrease pain. We have been doing a significant amount of scientific research of late on this procedure and have recently published our outcomes which show significant functional improvements and pain reduction,

If you are active and under 50 and have shoulder arthritis, you can discuss with your doctor about the various options for you.

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