drhornorthopedics.com

• Shoulder arthritis is a progressive disease defined by inflammation of the shoulder joint.  The most common symptom of arthritis of the shoulder is pain, which is aggravated by activity and progressively worsens.  If the glenohumeral shoulder joint is affected, the pain is centered in the back of the shoulder and may intensify with changes in the weather. Patients complain of an ache deep in the joint.

  • Limited motion is another common symptom. It may become more difficult to lift your arm to comb your hair or reach up to a shelf. You may hear a grinding, clicking, or snapping sound (crepitus) as you move your shoulder.

  • As the disease progresses, any movement of the shoulder causes pain. Night pain is common and sleeping may become difficult.

 

• Examination

  • Clinical findings of shoulder arthritis include signs of limitation of motion, atrophy or wasting of muscles, swelling, crepitus (clicking,popping, or crunching sound) and tenderness to touch.

  • Discomfort to all planes of motion and tenderness to touch along the biceps tendon in the front of the shoulder are also common clinical findings.

 

• Imaging

  • Shoulder arthritis can often be diagnosed and graded (classified by severity) on simple in office x-rays.  The findings seen on x-rays are related to the breakdown of cartilage and include loss of smooth surfaces of the joint, loss of joint space, and bone spurs.

  • CT- scan imaging is a helpful tool that can demonstrate multiple important findings in regards to severity of arthritis, type of arthritis wear pattern, and is used in surgical planning for shoulder replacement surgery. 

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Conservative Treatment

• •  Non-operative management of rotator cuff tears consists of a combination of activity modification, physical therapy, anti-inflammatory medications, and cortisone injections. 

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• Surgical Treatment

  • Modern advancements in shoulder replacement surgery have resulted in high rates of successful outcomes for patients with osteoarthritis.2-3 It is therefore not surprising that more patients are being treated with a shoulder replacement than ever before.  In fact, over the last several years, the number of shoulder replacements performed in the United States has increased at a faster rate than even hip or knee replacements.

  • Modern Total Shoulder Replacement surgery has shown clinical success rates of 93-95% with improvements in pain relief and restoration of shoulder function.2-3 Thus, for a patient with severe osteoarthritis of the shoulder who has failed attempts at conservative treatment, a total shoulder replacement is a remarkable surgical alternative.  Following a shoulder replacement, patients are typically able to return to previous activities with improved ability.  A recent study of over 300 patients found that speed of recovery occurred at 70% functional recovery at 3 months and 100% at 6 months.6  In fact, over 70% of patients treated with a shoulder replacement noted improvements in their ability to play tennis, golf, and swim.3

  • Many patients initially fear undergoing a shoulder replacement based on anecdotal experiences of others who were treated in the past.  Several recent studies have investigated the risks involved in shoulder replacement surgery.  As a recent study from Johns Hopkins University illustrated, total shoulder replacement is actually safer than hip or knee replacement surgery with a 50% lower complication rate and shorter hospital stays.1 Complication rates were also 50% lower in patients treated by surgeons who perform a high volume of shoulder replacement surgeries.4-5  Patients should therefore be encouraged to seek out a shoulder specialists who routinely perform a high volume of shoulder replacement to best determine if a shoulder replacement is indicated.

  • Whether to proceed with a total shoulder arthroplasty should be a quality of life decision.  If the patient’s quality of life is dramatically affected by shoulder pain and loss of function from arthritis, then a total shoulder arthroplasty should be strongly considered.  

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