Alternate names: Glenohumeral arthritis (OA), Arthropathy
Shoulder arthritis is the progressive wear and tear of the ball and socket joint of the shoulder and is characterised by increasing stiffness and pain. It usually affects older patients.
The majority of cases develop over time, but it can also be caused by injury. Shoulder arthritis is occasionally associated with recurrent dislocation of the shoulder or untreated rotator cuff tears.
Increasing stiffness and pain, usually built up gradually over a long period of time.
Usually just an x-ray of the shoulder, but occasionally further investigations of the soft tissue may be required with an ultrasound scan or MRI scan. Occasionally a CT scan is performed to help with planning surgery.
Unlike arthritis of the hip or knee, which progress rapidly, the shoulder joint can be arthritic for many years and cause only mild symptoms. Therefore, first line treatment consists of painkillers, anti-inflammatory drugs and physiotherapy.
Only when pain and stiffness become intrusive and particularly when pain occurs at night and cannot be resolved, would surgery be required.
The surgical solution is to replace the shoulder joint. There are three basic varieties, a surface replacement, a total replacement and a reverse polarity replacement.
The surface replacement is designed to remove a minimum of the patient’s bone and involves replacing the cap at the head of the humeral (upper arm) bone. The cup part of the joint (glenoid) is mostly left in place.
A total replacement involves replacing both the ball and socket parts of the joint with a metal ball on a stick fitting into the upper arm bone (humerus) and a plastic cup fixed to the glenoid.
A reverse polarity replacement is performed in special circumstances when there is arthritis as well as a massive rotator cuff tear which cannot be repaired. The rotator cuff is the group of muscles and tendons that make the shoulder move. When it is severely damaged, it significantly affects the way the shoulder moves and makes the classic joint replacement unsuitable. However a relatively new type of replacement has been developed where the ball and socket are reversed (the cup goes on the end of the arm bone while the ball is attached to the scapula (shoulder blade). The mechanics of this artificial joint are far more effective in patients with irreparable rotator cuff tears.
Patients who have a shoulder replacement can expect a good result, particularly in terms of pain relief. However, while they will regain a good range of movement, it is never a full recovery despite the best efforts of the patient and physiotherapy.
The specific aims of rehabilitation are to restore range of motion and power to the arm to allow a reasonable return to function. The specific physiotherapy will depend on the type of procedure.