Shoulder pain and rheumatoid 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.
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The shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone)
Two joints govern most shoulder movement. The acromioclavicular (AC) joint is located between the acromion and the clavicle. The glenohumeral joint is a ball-and-socket type joint formed by the head of the humerus and the shallow cup of the glenoid. The shoulder is enclosed inside a joint capsule. 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.
The rotator cuff is a structure composed of tendons that, with associated muscles, holds the ball at the top of the humerus in the glenoid socket and provides mobility and strength.
Bursae, small fluid-filled sacks, permit smooth gliding between bone, muscle, and tendon. They cushion and protect the rotator cuff from the bony arch of the acromion.
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.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.
Rheumatoid arthritis of the shoulder may require physical therapy and additional medicine, such as corticosteroids given by injection. More recently, the addition of disease-modifying anti-rheumatic drugs (DMARDS) and biologic medicines have allowed patients with rheumatoid arthritis to go into remission.
The old days of severe shoulder destruction due to rheumatoid arthritis are gone except for those patients who developed their disease before the advent of biologic therapy.
Generally, patients with rheumatoid arthritis will have many other joints involved with the disease if the shoulder is involved. Shoulder involvement usually occurs late in the course of the disease.
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 causing parts to loosen and move out of place, shoulder joint replacement (arthroplasty) may provide better results.
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