by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
Arthritis can affect any joint in the body and as a result, the shoulder is commonly affected by many types of arthritis.
The shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone).
Two joints help with shoulder movement. The acromioclavicular (AC) joint is located between the acromion (part of the scapula) and the clavicle. Between these two bones is a thin mayer of cartilage.
The glenohumeral joint is a ball-and-socket type joint that helps move the shoulder move in a number of directions including flexion, extension, abduction (moving away from the body), adduction (moving toward the midline), and rotation. The "ball" is the top, rounded portion of the upper arm bone (humerus); the "socket," or glenoid, is a cup-shaped part of the scapula into which the ball fits.) The capsule is an envelope that surrounds the glenohumeral joint. It is lined by a thin, smooth synovial membrane.
The bones of the shoulder are held in place by muscles, tendons, and ligaments. Tendons are tough cords of tissue that attach the shoulder muscles to bone and assist the muscles in moving the shoulder. Ligaments attach bones to each other, providing stability. As an example, the front of the joint capsule is anchored by three glenohumeral ligaments.
The rotator cuff is a structure composed of four tendons that, with their associated muscles, hold the ball at the top of the humerus in the glenoid socket and provide mobility and strength for the shoulder joint.
Two sac-like structures, called bursae, permit smooth gliding between bone, muscle, and tendon. They cushion and protect the rotator cuff from the bony part of the acromion.
The shoulder is the most mobile joint in the body. However, it is an unstable joint because of the mechanical disadvantage of the joint. The ball of the upper arm is larger than the shoulder socket that holds it. For stability, the shoulder must be anchored by its muscles, tendons, and ligaments. Unfortunately, since the glenoid is rather shallow, the joint is inherently unstable.Shoulder problems arise from injury to soft tissues as a result of both overuse and as well as degenerative processes.
Shoulder pain may be localized or may be referred down the arm. Other diseases such as gallbladder, liver, or heart disease, or arthritis affecting the cervical spine also may cause pain that travels along nerves to the shoulder.
Here are some of the ways doctors diagnose shoulder problems:
• Medical history (the patient tells the doctor about trauma or other condition that might be causing the pain).
• Physical examination to palpate for injury and stress the joint as well as to check for range of motion and instability.
Tests to confirm the diagnosis of certain conditions might be ordered. Some of these tests include:
o X-ray which is useless for soft tissue problems but valuable for diagnosing fracture
o MRI (magnetic resonance imaging)
More recently, diagnostic ultrasound has been found to be extremely useful for assessing shoulder problems.
Arthritis not only affects joints; it may also affect supporting structures such as muscles, tendons, and ligaments.
The usual signs of degenerative arthritis of the shoulder are pain, particularly over the AC joint, and a decrease in shoulder motion. Osteoarthritis of the glenohumeral joint is less common but also causes pain directly over the shoulder joint. A doctor may suspect the patient has arthritis when there is both pain and swelling in the joint. The diagnosis may be confirmed by a physical examination and x rays. Blood tests may be helpful for diagnosing rheumatoid arthritis, but other tests may be needed as well. Analysis of synovial fluid from the shoulder joint may be helpful in diagnosing some kinds of arthritis.
Most often osteoarthritis of the shoulder is treated early on with non-steroidal anti-inflammatory drugs. Corticosteroid injections may also be used. The approach to rheumatoid shoulder involvement is similar. Platelet-rich plasma (PRP) has been used to treat both osteoarthritis as well as tendon degeneration affecting the shoulder. Autologous stem cell therapy (a patient's own stem cells) also have been used with some degree of success in glenohumeral osteoarthritis. This procedure has enabled a number of patients to avoid more complicated shoulder surgery, including shoulder replacement.
When non-operative treatment of arthritis of the shoulder fails to relieve pain or improve function, shoulder joint replacement (arthroplasty) may provide better results. In this operation, a surgeon replaces the shoulder joint with an artificial ball for the top of the humerus and a cap (glenoid) for the scapula.
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Click here Second Opinion Arthritis Treatment Kit
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