Shoulder arthritis | Stewart Orthopaedics

Netcare Sunninghill Hospital
Tel: 011 257 2179

Sandton MediClinic Hospital
Tel: 011 463 8830 | 011 463 8833

Shoulder

arthritis

Normal anatomy of the shoulder

The shoulder is made up of three bones: The upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle).

The shoulder is a ball-and-socket joint: the ball, or head, of the humerus fits into a shallow socket (glenoid) in your shoulder blade.

The head of the humerus and the glenoid socket are covered by articular cartilage which is smooth and, together with the joint fluid, act to reduce friction between the 2 surfaces during movement.

The rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm. The rotator cuff also helps to secure the humeral head within the shoulder socket.
There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm.

Arthritis

Arthritis is an age related degenerative condition which results in the cartilage covering the humeral head and glenoid socket to wear out. This leaves a rough joint surface with the formation of bony spurs. End-stage arthritis is painful and can cause stiffness and a grinding or grating feeling in your shoulder.

Due to similar age related ‘wear and tear’, the rotator cuff tendons surrounding the joint may also tear resulting in weakness of the shoulder joint.
In some patients arthritis may develop early as a result of an autoimmune arthritis, such as Rheumatoid, or following a fracture of the shoulder joint.

Symptoms:

- - Pain – often a dull ache which is worse at night and with movement.
  - Reduced movement – difficulty with overhead activities and putting your hand behind your back.
  - Mechanical symptoms – such as a clicking, grating or catching sensation inside the shoulder.

Treatment

Unfortunately this condition is not reversible and worsens over time. Mild to moderate arthritis is typically managed with non-surgical management, however severe arthritis is best managed with a joint replacement.

Non-surgical treatment

The risk of having another shoulder dislocation on the same shoulder depends on:

- - Rest – I recommend wearing a sling 24 hours a day for the first 2-3 weeks while the ligaments and torn capsule are healing
  - Activity modification – Avoid activities that cause a feeling of apprehension that the shoulder may dislocate. This position of your shoulder when your hand is on top of your head is the typical position which will give a feeling that the shoulder is about to dislocate
  - Non steroidal anti-inflammatory medication – Medication such as Voltaren and Naproxen can reduce pain and inflammation around the shoulder.
  - Physiotherapy – Specific exercises under the guidance of a physiotherapist can restore movement and strengthen your shoulder. Strengthening the rotator cuff muscles that support your shoulder can relieve pain and prevent further instability
  - Steroid injection – If rest, medications, and physical therapy do not relieve your pain, an injection of a local anaesthetic and a cortisone around the tendons may be helpful. Cortisone is a very effective anti-inflammatory medicine; however, it is not
    effective for all patients and should be used with caution in diabetics.

Surgical management

There are 2 different types of shoulder replacements available. A conventional ‘anatomical’ total shoulder replacement and a reverse total shoulder replacement

For more information please read the booklet below

Netcare Sunninghill Hospital
Tel: 011 257 2179

Mediclinic Sandton Hospital
Tel: 011 463 8830
or 011 463 8833