What is shoulder arthritis?
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
arthritis.
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.
What tests can
the doctor do to prove if arthritis is present?
Most advanced cases of arthritis can be diagnosed with an x-ray evaluation
of the shoulder. Sometimes, with rheumatoid or other types of "inflammatory"
arthritis, special blood tests or other evaluations are needed.
What is the best
treatment for arthritis of the shoulder?
The treatment of shoulder arthritis depends on how disabling and painful
the disease is. Often your doctor will refer you to a rheumatologist who
specializes in treating arthritis with medications. Physical therapy,
particularly hydrotherapy (swimming pool), is very soothing, and helps
maintain or regain range of motion of the joint, and strengthen the surrounding
muscles. If the arthritis is advanced, causing severe pain and disability,
then your doctor may consider an operative procedure. Some early arthritis
can be treated with arthroscopic (microsurgical) techniques. With this
operation, the doctor will trim out the inflamed synovial lining tissue
and remove debris and pieces of degenerated cartilage. Of course, this
will not cure the arthritis, but frequently can relieve many of the symptoms,
at least for a while. In severe disease, the only surgical treatment is
joint replacement. This is a very good operation for pain relief and often
will restore some motion, but it has its limitations. The joint surfaces
are surgically replaced through a five inch incision in the front of the
shoulder, and a metal ball and plastic socket are inserted.
If total shoulder
joint replacement is needed, what are some of the risks?
The risks of total shoulder replacement are those of any standard surgical
procedure and include infection, anesthesia risks (including death), nerve
and vascular injury about the shoulder, and failure of the operation.
If the operation fails, it may result in stiffness or sometimes a loose
joint. If the joint becomes loose, it may either have to be redone at
a future date, or reoperated to have the ligaments or muscles tightened.
In the shoulder joint, this is quite a rare occurrence, although long-term
follow-up of more than 10 years is not yet available.
What is the postoperative
treatment after shoulder replacement?
If the shoulder was extremely tight, the doctor prefers to support
the arm in a brace after surgery that allows the muscles and ligaments
to heal in a lengthened position. If the shoulder was not particularly
tight, then the arm can be kept in a sling at the side. Exercises begin
on the day after surgery, and include movement of the elbow, wrist and
hand, and exercising the grip with putty. Shortly thereafter, rotational
pendulum exercises can be added. Strengthening exercises begin at about
three weeks when the brace or sling is removed. This delay is necessary
to allow the tissues that were opened at the time of surgery to heal.
How long will it
take my shoulder to improve to its maximum?
The shoulder will generally continue to improve quite steadily up
to five to six months after surgery. After that point, further improvement
is very slow; although it has been shown that even after a year or more,
activity can increase as muscle strength continues to improve. It is very
important to continue an exercise program to regain and maintain excellent
muscle strength around the new shoulder joint.
