Are you experiencing shoulder pain, stiffness, decreased mobility, clicking or cracking in your shoulder joint?
These are typical symptoms of arthritis, one of the most common causes of shoulder pain, especially as we age.
Understanding arthritis and the anatomy of the shoulder can help guide you in your search for relief. Dr. Kevin M. Supple, an EmergeOrtho orthopedic surgeon who specializes in shoulders, explains essential information you need to know to be best prepared to combat your shoulder arthritis.
What is arthritis?
In its broadest sense, arthritis is simply joint inflammation. It refers to the wearing away of the cartilage layer that allows our joints to move in a smooth and pain-free way. While there are many types of arthritis and its causes, the normal wear and tear on the bones as we age is known as osteoarthritis.
What you need to know about the shoulder joint
In order to best understand shoulder osteoarthritis and the available treatment, it’s helpful to be familiar with shoulder anatomy.
The shoulder is made up of three bones: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collar bone). Its unique design allows for the greatest amount of movement of all the human body joints.
Most shoulder movement occurs through the joint between the upper arm and shoulder blade, which is frequently referred to as a “ball-and-socket” joint. The upper end of the humerus, called the humeral head, is the “ball” and the corresponding “socket” on the shoulder blade is called the glenoid. Most of the time, arthritis of the shoulder occurs in this ball-and-socket or gleno-humeral joint.
Pro Tip Analogy!
The ball and socket of the shoulder joint are comparable to a golf ball on a golf tee in that the “ball” is relatively large compared to the “socket.”
For this reason, the shoulder has far more range of motion than any other joint, but there is a tradeoff. This design that allows increased movement of the shoulder also creates much less stability between the ball and the socket. The muscles, tendons, and ligaments surrounding the joint enhance stability.
The shoulder joint’s ability to move smoothly is made possible by the joint’s cartilage. This glistening covering over the joint surface allows frictionless movement between the humeral head and glenoid, functioning similarly to a nonstick coating of a frying pan. When the cartilage layer wears away, however, the underlying bone is exposed, creating a rough and unyielding surface. As the roughened surfaces grind against one another, pain and inflammation or swelling, can result. The joint surfaces can also become worn in a way that changes their shape, often leading to loss of range of motion.
How do I know that my shoulder pain is coming from arthritis?
Most often a standard x-ray can provide your orthopedic surgeon with the necessary information to diagnosis shoulder arthritis. Diagnostic studies such as an MRI or CT scan can often provide additional information.
What are treatment options for shoulder arthritis?
It is important to discuss your condition with your doctor to decide on the best treatment for you. Normally, treatments are recommended based on the severity and duration of a patient’s symptoms, and may include any of the following or a combination of two or more:
- individualized activity modifications
- physical therapy
- dietary adjustments and/or supplements
The arthritic shoulder joint tends to better tolerate activities such as “pulling” exercises, including biceps curls and horizontal rows, as well as swimming is a good low impact exercise option. Gentle stretching exercises, performed within your pain tolerance, may also help you maintain your flexibility.
Avoiding activities that are highly repetitive or that heavily load the shoulder joint may be of benefit. “Pushing” movements such as bench press and push-ups tend to compress across the joint, grinding the roughened arthritic surfaces against one another and potentially aggravating symptoms. Avoid aggressive stretching and be sure to consult your doctor before starting or modifying your exercise program.
Exercise has been shown to help improve pain and function in patients with arthritis. An individualized plan of care, including patient education and proper exercise instruction by a licensed Physical Therapist can provide lasting benefits for shoulder arthritis patients.
The over-the-counter analgesic acetaminophen (Tylenol) can help relieve pain. To reduce both inflammation and the pain that inflammation causes, an over-the-counter NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Advil) or naproxen sodium (Aleve) can be taken. There are also a number of prescription NSAIDs.
It is recommended to start with the lowest effective dose and monitor for side effects. NSAIDs should be avoided in people with a history of GI ulcers, kidney disease, and/or uncontrolled hypertension. It is always recommended to discuss medications with your general medical provider before use.
Voltaren gel is a topical NSAID that is available over-the-counter, as are various analgesic creams.
Commonly used cortisone injections can provide temporary relief for many, but results can vary. It is recommended to space these out as much as possible since the injections tend to lose their effectiveness with time, and repeated injections into the same area can potentially weaken the tissues.
There are a multitude of nutritional supplements with claimed health benefits. Both fish oil and turmeric, for example, have demonstrated anti-inflammatory benefits. Be sure to consult your physician or dietitian and/or nutritionist before using any nutritional supplement.
When all conservative options have failed, surgery can be an option.
Arthroscopic surgery to change or “remove arthritis” from the ball-and-socket joint has, unfortunately, not been found to be helpful, and in certain cases can actually “accelerate” arthritis. A rare exception is removing a piece of loose cartilage or bone causing mechanical symptoms.
Most surgical options are directed at joint replacement. There are some experimental resurfacing procedures, but currently the gold standards are total shoulder arthroplasty, for patients who have a healthy rotator cuff (muscles supporting the shoulder), or a reverse shoulder arthroplasty in patients who have a combination of arthritis and a torn or non-functioning rotator cuff.
Thankfully, with continuing advances in both surgical techniques and prosthesis design, combined with new options to manage post-operative pain, have made shoulder replacement a predictable and gratifying operation. It can reliably improve and often eliminate pain, and most times, it improves overall function.
To find out if you are a candidate for shoulder replacement surgery or if you simply have concerns about shoulder pain, please see the options below to schedule your appointment with Dr. Kevin M. Supple.
Schedule Online: Click Schedule An Appointment
Schedule by Phone: Call 336-545-5001 to speak with one of our EmergeOrtho Appointment Representatives.