Many middle aged or older adults with shoulder pain often assume that their pain is due to arthritis. This is a reasonable assumption. Arthritis is common in the knee, hip and back as you age and it would only stand to reason that the shoulder joint is no different. Except this would be wrong.
The fact is that other shoulder problems like rotator cuff injuries are far more common than arthritis in the older adult. Why do people make this mistake? I think there are a few reasons.
The first is a common human error: putting more stock in that which is seen versus what is unseen.
The first test most patients receive when they get their shoulder pain evaluated by their doctor is an x-ray. When parts of your shoulder age, they can look like they have arthritis. But if your pain is not in the same place as the “arthritis” on the x-ray, then the x-ray finding may be a red herring: simply a distracting finding. In other words normal, aging can be confused with arthritis. If the doctor who told you you had arthritis didn’t match the x-ray up with a specific finding then perhaps you are being misled.
This brings us to problem two.
There are 4 main joints in the shoulder. But only two tend to get arthritis commonly: the AC (acromioclaviclular) joint and the ball and socket (glenohumeral- GH) joint. Arthritis in each of these joints occurs at different rates, is painful in different ways and is treated differently.
When you say shoulder, most people probably think of the ball and socket portion of the joint, not the AC joint. But arthritis in ball and socket joint is actually LESS common than in the smaller AC joint.
Let’s explore further.
AC Joint Arthritis: The best and worst types of arthritis
If you have AC joint arthritis, you know why it is the worst type of arthritis: It is PAINFUL!
It’s hard to sleep, you get stabbing pain when you lift anything with your arm, and you can’t even carry a bag over your shoulder on the affected side. How possibly could it be the best type of arthritis, then?
Simply put, it often goes away on its own. And if it doesn’t, it is typically a straightforward surgical fix.
The AC joint is the small joint that exists where the collarbone and shoulder blade meet. You may feel it as a small bump on top of your shoulder. Arthritis in this joint is like arthritis in any other joint in the sense that the cartilage between the two bone surfaces has worn away, causing inflammation, and pain.
AC joint arthritis is common in individuals who do heavy work for a living such as construction. It’s also common in people who have heavy hobbies, such as weight lifting. But it can happen to anyone. In fact most people develop the x-ray appearance of AC arthritis, just by aging.
It is a relatively straightforward diagnosis to make, but only if your doctor is looking for it. The clinical exam is absolutely the most important part of making the diagnosis.
If your doctor hasn’t put his or hands on you, be suspicious if you are told that you have AC joint arthritis.
X-rays will show bone spurs and a narrowed space between the shoulder blade and collarbone. But these findings alone don’t necessarily mean that you need treatment. X-ray findings should always be matched to your symptoms. Remember, your doctor should treat you, not your x-ray.
What to do when you’ve been diagnosed with AC joint arthritis
Remember earlier when I said it’s one of the best types of arthritis to have?
It’s one of the best types because if you give it enough time or a cortisone injection, it often becomes pain free on its own. No the cartilage does not come back. But for some reason in certain people, the joint inflammation just goes away and the shoulder becomes functional again. This is why it’s often a good idea to wait a little while before considering surgery for this problem.
I’ve had a number of patients who received one or two cortisone injections into the AC joint and their pain disappeared forever.
Of course I have had many others for whom conservative measures did not work so well. Every case is different. Sometimes the pain is relentless and more involved treatment is necessary.
The other reason why it’s the best type of arthritis is because if it doesn’t go away on its own, then a low risk, minimally invasive, same day procedure can usually fix the problem. No fancy joint replacement is necessary.
The bottom line is that AC joint arthritis is real. It is common. And it is very treatable.
Dr. DiPaola has performed hundreds of arthroscopic shoulder procedures. He routinely treats arthritis of the AC joint with both conservative measures and arthroscopic surgery. If you have shoulder pain and would like more information or a personal consultation please contact us.