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Shoulder Arthritis

What is shoulder arthritis?

Shoulder arthritis is a painful condition caused by the breakdown of cartilage, the smooth, soft tissue that lines the gleno-humeral (ball and socket) joint and aids joint movement. As cartilage breaks down, the levels of joint inflammation and thus pain increase. The bone tends to remodel leading to small bony outgrowths (osteophytes) which can cause restriction of shoulder joint movement.

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Who is affected by shoulder arthritis?

Shoulder arthritis is more common in older adults, but it can affect people of all ages. It is also more common in people who have certain risk factors, such as:

  • A previous history of shoulder injuries

  • Obesity

  • Family history of arthritis

  • Certain occupations, such as those that require frequent or repetitive overhead movements

What are the main symptoms of shoulder arthritis?

 

The most common symptoms of shoulder arthritis are pain, stiffness and restriction of range of movement, particularly seen with rotational movements, for example when putting your hands behind your head or behind your lower back. Pain may be felt in the shoulder itself, or it may radiate down towards the outer arm and even into the elbow. Pain is usually worse with activity and improves with rest but can also be troublesome after periods of inactivity, for example on waking in the morning with increased stiffness and restriction.

Other symptoms of shoulder arthritis may include:

Reduced range of motion

Swelling

Crepitus, a popping or grinding sound with movements of the shoulder

Weakness in the shoulder and arm

Diagnosis of shoulder arthritis

In order to diagnose shoulder arthritis, your doctor will typically ask about your medical history and perform a physical exam. The doctor may also order imaging tests, such as X-rays, ultrasound or MRI scans, in order to make a formal diagnosis and to clarify the extent of the degenerative change within the ball and socket joint, and to rule out other potential causes of shoulder joint pain and restriction.

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Treatment of shoulder arthritis

 

There is no way to reverse the cartilage degeneration with any joint but for shoulder arthritis there are a number of treatments that can help to reduce pain and improve function. Treatment options may include:

Non-surgical treatments

  • Physiotherapy to strengthen the muscles around the shoulder and improve range of motion
  • Over-the-counter pain relievers, such as ibuprofen, naproxen, paracetamol and codeine
  • Prescription pain relievers
  • Corticosteroid injections to reduce inflammation

The best treatment option for you will depend on the severity of your arthritis, your overall health, your activity levels and the functional requirements for your shoulder.

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Non-surgical treatments are often the first line of treatment for shoulder arthritis. These treatments can help relieve pain and improve function, but they cannot stop the progression of the disease.

Physiotherapy is one of the most effective non-surgical treatments for shoulder arthritis. A physiotherapist will provide you with a series of exercises to help strengthen the muscles around the shoulder and improve range of motion. Physiotherapy can also help you to perform activities of daily living in a way that reduces pain and inflammation.

Over-the-counter pain relievers, such as ibuprofen, naproxen or paracetamol can be effective for relieving mild to moderate pain from shoulder arthritis. However, these medications can cause side effects, such as stomach upset and bleeding, so they should be used with caution and on advice from your doctor.

Corticosteroid injections can be a highly effective way of reducing inflammation and pain in the shoulder joint. At The Joint Injection Clinic, corticosteroid injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor.  The experienced medical doctor will then place you in a side-lying position with the affected shoulder upmost and with the hand of the affected shoulder placed on the opposite side of the chest.  The shoulder is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions.  Local anaesthetic is injected from the skin to the joint under ultrasound guidance.  After giving the local anaesthetic a few minutes to take effect, the shoulder joint injection is performed with a small dose of steroid and local anaesthetic, targeting the back part of the ball and socket joint. 

The injection itself is normally completed within 30-60 seconds, after which a plaster is applied and post-injection advice is given.  The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever.  If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed.  The patient is also warned that following any injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours).  This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.

Surgery

Surgery is an option for patients with shoulder arthritis whose pain is not controlled by non-surgical treatments. The two most common types of surgery for shoulder arthritis are arthroscopic surgery and total shoulder replacement.

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Lifestyle changes

In addition to medical treatment, there are a number of lifestyle changes that can help manage shoulder arthritis pain and improve function. These include:

  • Maintaining a healthy weight
  • Exercising regularly
  • Avoiding repetitive overhead movements

If you have shoulder arthritis, it is important to work with your doctor to develop a treatment plan that is right for you. With early diagnosis and treatment, most people can manage their arthritis and maintain a good quality of life.

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