Shoulder Arthritis / OA / Wear & Tear
WHAT IS IT?
Osteoarthritis is a progressive degeneration of the joints. It results when the protective surface (cartilage) that allows the joint to move smoothly is damaged. Over time this cartilage is worn away and adjacent bones are remodeled as the joint becomes increasingly abnormal and ‘rusty’, resulting in pain and stiffness.
Osteoarthritis of the shoulder is less common in comparison to many other joints, principally the hips, knees, and hands. It is nonetheless a debilitating problem and can have a significant impact on the patient’s life.
Traditionally thought of as a ‘wear and tear’ phenomenon the cause of osteoarthritis is generally unknown however several contributing factors have been identified these include; prior shoulder surgery, history of trauma, inflammatory conditions (mainly Rheumatoid arthritis), and shoulder overuse. Individuals particularly at risk are those who engage in high intensity overhead activities such as weightlifters and racquet sport players.
Rheumatoid arthritis is a widespread disease found throughout the body in which the patients own immune system mistakenly attacks the joints causing widespread inflammation and damage.
Patients with arthritis of the shoulder will classically complain of a stiff and painful shoulder, with a limited range of movement. Description of pain and stiffness that intensifies with use is common as is painful interruption of sleep. “Catching” and “noise” heard during movement is another routine finding.
Osteoarthritis is usually diagnosed by a combination of clinical examination and history of the presenting complaint. Prior to proceeding with treatment, X-rays may be taken to evaluate the extent of any damage which may be helpful in deciding upon the most suitable treatment.
Non-operative treatment should always be exhausted prior to proceeding with any form of surgery. Possible non-operative options available include:
1. Physiotherapy – to prevent any further stiffness and regain range of motion
2. Painkillers and anti-inflammatories – mild/ moderate pain killers and anti-inflammatory medications may be taken to provide symptomatic relief. However these drugs are in no way curative and will not alter the course of the disease.
3. Ultrasound guided steroid injections are often given to provide short-term relief to the patient, though this period is unpredictable due to the wide variability of the disease. Repeated injections should not be given as a long term cure as they can cause further damage to the joint.
4. Hyaluronan injections – have been shown to be beneficial for early arthritis and where surgery is contraindicated. They seem to provide longer benefit than steroid injections with less side-effects. However, they are more costly.