Glenohumeral (shoulder) arthritis is a common source of pain and disability that affects up to 20% of the older population. Damage to the cartilage surfaces of the glenohumeral joint (the shoulder's "ball-and-socket" structure) is the primary cause of shoulder arthritis.
There are many treatment options for shoulder arthritis, ranging from pain medications and exercises for mild cases, to surgical procedures for severe cases. Treatment decisions are based upon the cause, the symptoms and the severity of the patient's disease. Each year, over 10,000 shoulder replacement surgeries are performed in the United States to relieve pain and improve function for shoulders that are severely damaged by glenohumeral arthritis.
The shoulder is the most mobile joint in the human body with a complex arrangement of structures working together to provide the movement necessary for daily life. Unfortunately, this great mobility comes at the expense of stability. Several bones and a network of soft tissue (ligaments, tendons, and muscles), work together to produce shoulder movement. They interact to keep the joint in place while it moves through extreme ranges of motion. Each of these structures makes an important contribution to shoulder movement and stability. Certain work or sports activities can put great demands upon the shoulder, and injury can occur when the limits of movement are exceeded and/or the individual structures are overloaded.
What is the labrum and what does it do?
The labrum is a disk of cartilage on the glenoid, or "socket" side of the shoulder joint. The labrum helps stabilize the joint and acts as a "bumper" to limit excessive motion of the humerus, the "ball" side of the shoulder joint. More importantly, it holds the humerus securely to the glenoid, almost as if suction were involved. Although the glenoid itself is a relatively flat surface, the labrum's cuff-like contour gives the glenoid a more concave shape. The secure but flexible fit of the humerus within the glenoid permits the great range motion of the healthy shoulder.
What is glenohumeral joint arthritis?
Glenohumeral joint arthritis is caused by the destruction of the cartilage layer covering the bones in the glenohumeral joint. This creates a bone-on-bone environment, which encourages the body to produce osteophytes (bone spurs). Friction between the humerus and the glenoid increases, so the shoulder no longer moves smoothly or comfortably. As osteophytes develop, motion is gradually lost. A number of conditions can lead to the breakdown of cartilage surfaces:
Pain from bone-on-bone rubbing within the joint is the most common symptom of glenohumeral arthritis
Loss of motion is another common symptom. Possible causes of motion loss include:
Other symptoms may be:
The doctor will first obtain a history of the patient's symptoms and health over the past several years. Those who suffer from shoulder arthritis typically report an increase in pain over several years. The doctor will ask if the patient has any conditions that may be the underlying cause of osteoarthritis such as:
Next, the doctor will do a physical examination of the shoulder to evaluate the symptoms and reveal other conditions that may exist.
X-ray imaging of the shoulder can confirm a diagnosis of glenohumeral arthritis. With x-ray, the doctor can see structural changes that indicate arthritis, such as:
Other imaging techniques used to make the diagnosis include:
Mild glenohumeral arthritis is often manageable with a regimen of:
Mild to moderate glenohumeral arthritis pain is often effectively controlled by using any one or a combination of the following treatments:
When severe shoulder arthritis pain is unmanageable with non-operative measures, surgical treatment may be recommended.
What types of complications may occur?
Even with the closest attention to detail, surgical complications may occur. Debridement surgery is typically less complex than arthroplasty. However, as with arthroplasty, the potential complications of bleeding, nerve injury, and infection are present.
Some of the more common complications are:
How painful is shoulder replacement surgery?
Shoulder arthroplasty is a complex procedure, which requires a great amount of cutting of deep tissues and bone. The surgeon takes great care to eliminate pain with appropriate analgesia both immediately after surgery and during the rehabilitation process. A long acting local anesthetic infused around the nerves of the joint is often used with general anesthesia during surgery. These regional blocks will provide several hours of pain relief even after a patient has emerged from general anesthesia. A patient-controlled intravenous infusion pump (PCA) is used in the early post-operative period for pain control. By the second or third day after surgery, oral pain relief medication is adequate through the early rehabilitation period (4-6 weeks).
How long before I can return to my normal activities after shoulder arthroplasty?
The time it takes to return to normal activity varies greatly from patient to patient. Most individuals have less pain at night or at rest in the first 2-4 weeks after surgery. Pain with activity persists longer, but generally decreases as the strength and function of the shoulder muscles improve. Full recovery usually takes 4-6 months.
What activities can I safely do after shoulder replacement?
The goal of shoulder arthroplasty is to relieve the pain from glenohumeral arthritis. It is unrealistic to expect to return to repetitive, heavy, overhead activities, which would put the replacement components at risk. Shoulder function after arthroplasty is also unlikely to allow the motions required by these activities.
According to the American Shoulder and Elbow Society, the acceptable activities after a shoulder arthroplasty are:
Unacceptable activities are:
I've heard that joint replacements sometimes "wear out" and need to be redone. What are the chances I may require a second shoulder arthroplasty?
Long-term studies show that 85-90% of total shoulder replacements are functioning well ten years after implantation, and 75-85% are doing well fifteen years after surgery. Over time, current advances in materials and techniques should improve these percentages even more.
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