Shoulder arthritis

Rotator cuff arthropathy and reverse shoulder replacement

What is shoulder arthritis?

Arthritis is the abnormal wearing down of cartilage in the joint.  Cartilage is the smooth, protective layer that acts like a cap at the end of bones in joints.  The complete cause of the most common type of arthritis, osteoarthritis, is still unknown.  We believe that it is a combination of genetic and activity related factors.  The other type of arthritis is called inflammatory arthritis and may include rheumatoid arthritis.  Arthritis in the shoulder is normally between the ball of the humerus and the socket of the shoulder blade.  Patients can also get arthritis between the shoulder blade and the collar bone, called AC joint arthritis.

I was told that I have arthritis because of a rotator cuff tear, what does that mean?

Arthritis after a rotator cuff tear, or rotator cuff arthropathy, is a different process than normal osteoarthritis.  This type of arthritis is due to the ball moving up on the socket because the torn rotator cuff can no longer hold the head of the ball in the socket.  This process damages the surfaces of all of the bones.  To learn more about rotator cuff arthropathy, continue reading here.

What are the symptoms of shoulder arthritis?

Pain is by far the most common symptom of arthritis of the shoulder.  This pain is normally aggravated by activity and worsens over time.  The pain may be felt as a deep ache or may be centered in the back of the shoulder.  This pain also normally intensifies with changes in the weather.  Night pain is also incredibly common with most shoulder problems.
Decreased range-of-motion is also very common with shoulder arthritis.  This may be secondary to pain or may be from a tight shoulder capsule or bone spurs.
How is shoulder arthritis diagnosed?

Shoulder arthritis is diagnosed by shoulder specialists, like myself, by a combination of the medical history, physical examination, and x-rays of the shoulder.  X-rays of the shoulder normally show significant narrowing of the joint space and formation of bone spurs.

How is shoulder arthritis treated?

As with most shoulder conditions, initial treatment of arthritis of the shoulder is nonsurgical.  I normally recommend a combination of the following:
•    rest or change activities to avoid provoking pain.
•    Home exercises or physical therapy to improve range-of-motion.  Continue reading here to see my home exercise protocol for shoulder arthritis.
•    Nonsteroidal antiinflammatory medications, such as aspirin, ibuprofen, or naproxen may help reduce inflammation and pain.
•    Heat or ice can sometimes help to reduce pain.

Sometimes, the symptoms of shoulder arthritis cannot be relieved without surgery.  In those cases, I may recommend surgical treatment.

What are the surgical options for shoulder arthritis?

The most common treatment with the best outcomes for shoulder arthritis is a shoulder replacement.  The most common is a complete shoulder replacement, where I replace the metal-ball and place a plastic socket to remove the arthritis.  Some younger patients may be a candidate for a procedure known as the “ream and run” procedure.  This procedure involves the placement of a metal-ball and the smoothing out of the socket without placing a new plastic socket.  This procedure is very good for a select group of younger, active patients.  The advantage of this procedure is that patients normally do not have restrictions after they complete a more extensive rehabilitation.

Patients that suffer from rotator cuff arthropathy, or have failed a previous shoulder replacement, may be candidate for a reverse shoulder replacement.  This procedure involves the placement of a plastic cup on the humerus and the metal-ball is screwed onto the shoulder joint.