Arthritis of the Shoulder

There are two joints in the shoulder that can be affected by arthritis:

• Acromioclavicular (AC) joint: This joint connects the clavicle (collar bone) to the shoulder blade (scapula). Pain from arthritis in the AC joint may be focused on the top of the shoulder and may radiate to the side of the neck.
• Glenohumeral joint: This joint connects the scapula to the humerus (upper arm bone). Pain from arthritis in the glenohumeral joint may feel like a deep ache in the side or back of the shoulder; pain can also worsen with weather changes.

Treatment will depend on the affected joint as well as what type of arthritis you have.

There are five types of arthritis that most often affect the shoulder:

• Osteoarthritis: Osteoarthritis is a condition in which the outer cartilage layer wears away, allowing the bones of the joint to rub against each other. This type of arthritis usually develops over time due to wear and tear, and it is more common in the AC joint.
• Posttraumatic arthritis: Posttraumatic arthritis is a type of osteoarthritis that develops after a traumatic injury, e.g., fracture or shoulder dislocation.
• Rheumatoid arthritis: Rheumatoid arthritis is an autoimmune disorder in which the body's immune system mistakenly attacks its own tissues, causing pain, swelling, and stiffness. The resulting inflammation can damage the affected joint.
• Rotator cuff tear arthropathy: A large rotator cuff tendon tear that is left untreated may develop arthritis. The combination of the arthritis and the original tear can cause severe pain, weakness, and reduced mobility.
• Avascular necrosis (AVN): Avascular necrosis can occur when the blood supply to the tip of the humerus is disrupted, leading to bone cell death, gradual collapse of bone tissue, and eventual arthritis in the bone and glenohumeral joint.

Symptoms of arthritis in the shoulder can include:

• Pain in the shoulder that is usually aggravated by activity or movement
• Pain that worsens over time
• Pain may be generally localized to the affected joint (see above) or may affect the whole shoulder, especially in cases of rheumatoid arthritis
• Pain that worsens at night
• Difficulty sleeping due to pain
• Stiffness in the shoulder
• Limited range of motion in the shoulder
• Crepitus (grinding, clicking, or snapping when moving the shoulder joint)

Treatment for arthritis of the shoulder is about symptom management. There is no known cure for arthritis, but proactive treatment can alleviate your symptoms and improve your quality of life.

• Anti-Inflammatory Medications: Non-steroidal anti-inflammatory medications can decrease inflammation and pain due to arthritis in the shoulder.
• Physical Therapy (PT): PT may be recommended to improve range of motion and strength in the shoulder. Controlled use of the shoulder joint can help to preserve function and prevent further damage.
• Lifestyle Modifications: Some patients will benefit from lifestyle modifications, such as limiting or stopping certain activities that cause or aggravate pain. Changing how you move your arm can help you avoid provoking pain. Applying moist heat may provide temporary relief, as can icing your shoulder in increments of 20 to 30 minutes a few times a day.
• Injections: Patients who need temporary pain relief or who cannot undergo surgery may benefit from injections. Corticosteroid injections can reduce inflammation and alleviate pain from shoulder arthritis.
• Surgery: If nonsurgical treatment does not relieve pain, or if your pain is debilitating, surgery may be advised. Surgical options include arthroscopy (using a scope to clear out arthritis debris) or arthroplasty (replacing damaged parts of the shoulder with artificial implants). Surgery is usually very effective in restoring motion and reducing pain from shoulder arthritis.