Although there is no cure for shoulder arthritis, there are many therapeutic options available. Using these, most people with arthritis can manage pain and stay active.
Simply defined, arthritis is inflammation of one or more of your joints. In a diseased shoulder, inflammation causes pain and stiffness. If you are experiencing shoulder pain, you should consult with a specialized shoulder surgeon in Seattle, Dr. Sara Jurek.
Your shoulder is made up of three bones: your humerus (upper arm bone), your clavicle (collarbone ), and your scapula (shoulder blade).
The head of the humerus fits into a rounded socket in your scapula. This socket is called the glenoid. A combination of muscles and tendons keeps the humeral head centered in the glenoid. These tissues are collectively called the rotator cuff.
There are two joints in the shoulder, and both may be affected by arthritis. One joint is located where the clavicle meets the tip of the shoulder blade (acromion). This is called the acromioclavicular (AC) joint.
The large ball-and-socket joint of the shoulder (where the head of the humerus fits into the glenoid) is called the glenohumeral joint.
To provide you with effective treatment, Dr. Jurek will determine which joint is affected and what type of arthritis you have.
Rheumatoid arthritis (RA) is a chronic disease that attacks multiple joints throughout the body. It is symmetrical, meaning that it usually affects both shoulders.
The joints of your body are covered with a lining — called synovium — that lubricates the joint and facilitates movement. Rheumatoid arthritis causes this lining to swell, which causes pain and stiffness in the joint.
Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its tissues. In RA, the defenses that usually protect the body from infection instead damage normal tissue (such as cartilage and ligaments) and soften bone.
Arthritis can develop after a large, long-standing rotator cuff tear. The torn rotator cuff no longer holds the head of the humerus centered in the glenoid, and the humerus moves upward and rubs against the acromion. This damages the surfaces of the bones, causing arthritis to develop over time.
The combination of a large rotator cuff tear and advanced arthritis can lead to severe pain and weakness, and patients may not be able to lift their arm away from their side or use their arm for any activity requiring strength. Learn More
Avascular necrosis (AVN) of the shoulder is a painful condition that occurs when the blood supply to the head of the humerus is disrupted. Because bone cells die without a blood supply, AVN can ultimately lead to the destruction of the shoulder joint and the development of arthritis.
Avascular necrosis develops in stages. As it progresses, the dead bone gradually collapses, damaging the articular cartilage covering the bone and leading to arthritis. At first, AVN affects only the humeral head, but as AVN progresses, the collapsed humeral head can damage the glenoid.
Causes of AVN include high dose steroid use, heavy alcohol consumption, sickle cell disease, and traumatic injury, such as fractures of the shoulder. In some cases, no cause can be identified; this is referred to as idiopathic AVN.
If you have any of the following symptoms for shoulder arthritis, call Dr. Jurek for a consultation:
Dr. Jurek will perform a comprehensive clinical examination to determine if you have shoulder arthritis.
History. She will talk with you about your symptoms and your medical history. She will discuss your work and lifestyle activities and also your goals for your shoulder.
Physical Exam. Dr. Jurek will perform a thorough examination of your shoulder, check the range of motion and strength, and perform specific tests to make the correct diagnosis.
X-Rays. X-rays are imaging tests that create detailed pictures of dense structures, like bone. They can help distinguish among various forms of arthritis. X-rays of an arthritic shoulder will show narrowing of the joint space, changes in the bone, and the formation of bone spurs (osteophytes).
MRI. Dr. Jurek may order an MRI (magnetic resonance imaging) of your shoulder. An MRI provides very detailed images of the soft tissue (cartilage, ligaments, tendons, and muscles) and the bone.
Both nonsurgical and surgical treatment options are available for shoulder arthritis. Conservative treatment may provide pain relief and reduce episodes of inflammation while avoiding the risks of surgery. Dr. Jurek may recommend surgery if your pain causes significant disability, impairs your desired quality of life, and is not adequately relieved with nonsurgical treatment.
As with other arthritic conditions, initial treatment of shoulder arthritis is usually nonsurgical. Dr. Jurek may recommend the following:
Activity Modification. Modifying your daily activities may dramatically improve your symptoms. This typically involves changing or reducing your activities to avoid provoking pain. You may need to change the way you move your arm to do things or adjust the amount or intensity of your activities.
Cold Therapy. Ice your shoulder for 20 to 30 minutes two or three times a day to reduce inflammation and ease pain. See Cold Therapy Options for more information.
Warm Compress. Use a warm compress in the mornings to relieve shoulder stiffness.
Physical Therapy. Stretching and strengthening exercises help to improve and maintain your shoulder’s range of motion while preserving function.
NSAIDs. A nonsteroidal anti-inflammatory medication, such as Motrin, Aleve, or Ibuprofen, may reduce inflammation and pain. These medications can be very effective in reducing the inflammation and pain caused by shoulder arthritis but can also irritate the stomach lining and cause internal bleeding. They should be taken with food. Consult with your primary care doctor before taking over-the-counter NSAIDs if you have a history of ulcers or are taking blood-thinning medication.
Corticosteroid Injection. A steroid injection can dramatically reduce the inflammation and pain caused by shoulder arthritis. The injection usually comprises a combination of a corticosteroid called Depo Medrol (Methylprednisolone Acetate) and a local anesthetic called lidocaine. Be sure to let Dr. Jurek know if you have an allergy to either one of these medications. The injection is performed during your clinic visit with Dr. Jurek.
Surgical treatment options to relieve symptoms of osteoarthritis may be necessary if you don’t respond to conservative treatment:
Shoulder Arthroscopy. Cases of mild shoulder arthritis may be treated with an arthroscopic procedure called a “CAM procedure” (CAM = Comprehensive Arthroscopic Management of glenohumeral osteoarthritis). Shoulder arthroscopy is minimally invasive and removes loose pieces of damaged cartilage and debrides (cleans out) the inside of your shoulder joint. Although the procedure provides pain relief, it will not eliminate arthritis from the joint or cure your arthritis. If arthritis progresses, further surgery may be needed in the future.
Shoulder Replacement (Anatomic Total Shoulder Arthroplasty). Advanced arthritis of the glenohumeral joint can be treated with shoulder replacement surgery, in which the damaged cartilaginous surfaces of the shoulder joint are removed and replaced with artificial components. This is called a total joint replacement, and it replaces both the head of the humerus and the glenoid. The ball-and-socket joint of the shoulder is replaced with an artificial one made of metal and plastic.
Reverse Total Shoulder Arthroplasty. In a reverse shoulder replacement, a shoulder replacement is performed with the positioning of the socket and metal ball opposite that of conventional total shoulder arthroplasty. A metal ball is fixed to the glenoid (socket), and a plastic cup is fixed to the upper end of the humerus. A reverse total shoulder replacement works well for certain conditions such as cuff tear arthropathy and certain types of fractures.
Hemiarthroplasty. This is a partial joint replacement where one-half of the shoulder joint, the humeral head, is replaced with a prosthesis, and the glenoid (socket) is left intact.
If you are suffering from shoulder arthritis or have a painful shoulder and need relief, seek advice and an accurate diagnosis. Call Dr. Sara Jurek at (206) 386-2600 today to schedule a consultation. You may also request an appointment online.
If Dr. Jurek recommends that you have a cortisone injection for your shoulder arthritis, you can expect the following:
Protect the injection site for a day or two. For example, if you received a cortisone shot in your shoulder, avoid heavy lifting or repetitive overhead lifting for 24 to 48 hours.
It is normal to have some increased discomfort in the injected region for the first 24 to 48 hours. Apply ice to the injection site 20 minutes at a time, 3 to 4 times a day as needed to relieve pain. Heat is generally not helpful in relieving the discomfort from the injection as it increases the inflammatory response.
For injection site soreness during the initial 24-48 hours, you may take the pain reliever acetaminophen (Tylenol). Limit this to a total of 3000 mg over the course of a 24-hour period, and do not take it if you have liver disease. You may also take an anti-inflammatory such as Aleve, Advil, Motrin, or Ibuprofen if you are not taking a blood thinner (Plavix, Coumadin, Eliquis, etc.), do not have bleeding tendencies, ulcers, acid reflux, etc., and you are not already taking other anti-inflammatory medications such as Meloxicam (Mobic), Celebrex (Celecoxib), Piroxicam (Feldene), etc. If you have any concerns, please talk to Dr. Jurek or your primary care physician prior to taking these medications.
Watch for signs of infection such as increasing pain, redness, and swelling lasting more than 48 hours. If you notice any signs of infection following your joint injection (fever greater than 101.5 degrees, redness, warmth, drainage), call Dr. Jurek's office immediately at (206) 386-2600.
You may shower immediately after the injection but do not soak in a bathtub, hot tub, or whirlpool for 48 hours.
If you have diabetes, a cortisone shot might temporarily increase your blood sugar levels. Be sure to monitor your glucose levels very closely in the 5 days following the injection. Your glucose levels should return to normal over this time. If they do not, please contact your primary care doctor.
The injection may also cause some patients to experience temporary redness and a feeling of warmth of the chest and face (called "flushing").
Some people have a brief increase in pain for 1 to 3 days after the injection, commonly referred to as a “steroid flare,” caused by crystallization of the cortisone. Rest, ice, and over-the-counter pain medicines may help relieve this temporary discomfort.
Additionally, there is a small risk of bleeding and a small risk of infection any time the skin is punctured, even with a very small, sterile needle.
Cortisone shots commonly cause a transient flare in pain and inflammation for up to 48 hours after the injection. Rest and ice are helpful to lessen the discomfort during this time. After that, the pain and inflammation of the injected joint should decrease, and these results can last up to several months.
Depending upon your particular medical condition and your response to a previous injection, Dr. Jurek may recommend that an injection be repeated after a safe amount of time has elapsed. Typically, she will wait 4 to 6 months before repeating injections to prevent damage or weakening to tissues over time.
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