Shoulder arthritis

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

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

Two joints are most responsible for shoulder movement. The acromioclavicular (AC) joint is located between the acromion (part of the scapula) and the clavicle.

The glenohumeral joint, commonly called the shoulder joint, is a ball-and-socket type joint that helps move the shoulder forward, backward, towards and away from the body, and allows the arm to rotate in a circular fashion. (The "ball" is the top, rounded portion of the humerus; the "socket," or glenoid, is a shallow cup-shaped part of the scapula into which the ball fits.) The capsule is a soft tissue envelope that encircles 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. For example, the front of the joint capsule is anchored by three glenohumeral ligaments.

The rotator cuff is a structure composed of tendons that, with their associated muscles, holds the ball at the top of the humerus in the glenoid socket and provides mobility and strength.

Sac-like structures called bursae permit smooth gliding between bone, muscle, and tendon. They cushion and protect the rotator cuff from the bony arch of the acromion.

The shoulder is the most movable joint in the body. However, it is an unstable joint. It is easily injured because the ball of the upper arm is larger than the shoulder socket that holds it. The shoulder requires anchoring by its muscles, tendons, and ligaments. Some shoulder problems arise from the disruption of these soft tissues as a result of injury or from overuse or underuse of the shoulder. Other problems arise from degenerative processes.

Shoulder pain may be localized or may be referred to adjacent areas. Other diseases such as gallbladder, liver, or heart disease, or disease of the cervical spine of the neck also may generate pain in the shoulder.

Arthritis is a degenerative disease caused by either wear and tear of the cartilage (osteoarthritis) or inflammation (rheumatoid arthritis) of one or more joints. Arthritis not only affects joints; it may also affect supporting structures such as muscles, tendons, and ligaments.

The usual signs of arthritis of the shoulder are pain and a decrease in shoulder motion. 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 or other imaging procedures such as diagnostic ultrasound or MRI. Blood tests may be helpful for diagnosing inflammatory forms of 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.

If the arthritis is inflammatory, then specific medical therapies need to be used.

The most common form of shoulder arthritis is osteoarthritis. Most often osteoarthritis of the shoulder is treated with non-steroidal anti-inflammatory drugs, physical therapy, and injections of glucocorticoid.

Recent reports have shown mesenchymal stem cells to be an effective treatment for significant shoulder arthritis.

When non-operative treatment of arthritis of the shoulder fails to relieve pain or improve function, or when there is severe wear and tear of the joint, shoulder joint replacement (arthroplasty) may provide better results.

Passive shoulder exercises (where someone else moves the arm to rotate the shoulder joint) are started soon after surgery. Patients begin exercising on their own about 3 to 6 weeks after surgery. Eventually, stretching and strengthening exercises become a major part of the rehabilitation program. The success of the operation often depends on the condition of rotator cuff muscles prior to surgery and the degree to which the patient is compliant with the exercise program.

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