Symptoms 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 consists of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone).

Two joints allow most shoulder movement. The acromioclavicular (AC) joint is located between the acromion and the clavicle. The glenohumeral joint, the major shoulder joint, is a ball-and-socket type joint that helps move the shoulder in most directions. (The "ball" is the rounded portion of the upper arm bone or 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 muscles to bone and assist the muscles in moving the shoulder. Ligaments attach bones to each other, providing stability.

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 to the shoulder joint.

Bursae (small sacks of fluid) 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 mobile joint in the body. However, it is an unstable joint because of the range of motion and the shallowness of the glenoid cup.

The shoulder is tethered 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. Other problems arise from a degenerative process.

Shoulder pain may be localized or may be referred to areas around the shoulder or down the arm.

Diagnosis of shoulder problems involves the following:

• Medical history.
• Physical examination.

Confirmatory tests such as MRI (magnetic resonance imaging)or diagnostic ultrasound may be ordered.

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 typical signs of arthritis of the shoulder is pain, either at the AC joint or deep in the glenohumeral joint. There is also a decrease in shoulder motion. Pain may also be felt along the outside part of the upper arm. The pain may be dull or aching. It may also be sharp. Pain may be present at night. Pain is often present when the arm is lifted above shoulder level. A patient may notice that the shoulder makes “crunching” sounds when they move it. Pain in the back of the shoulder often is referred from the neck.

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 with non-steroidal anti-inflammatory drugs. (Rheumatoid arthritis of the shoulder may require physical therapy and additional medicine, such as corticosteroids.)

Other therapies may include steroid injections, viscosupplements, platelet-rich plasma (PRP), or stem cells. Stem cells have been used successfully in active adults who have shoulder arthritis as a result of sports activities played when they were younger.

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 with instability, shoulder joint replacement (arthroplasty) may be necessary.

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