Chances are you or someone you know has suffered with knee or hip arthritis and even had a knee or hip replacement. It’s less likely that you know someone who has had a shoulder replacement. This is because arthritis is much less common in the ball and socket joint of the shoulder than it is in either the knee or hip.
Like arthritis in other joints, having glenohumeral (GH) arthritis literally means that you have inflammation in the bearing surface of your joint. The bearing surface is usually lined with cartilage, and in a normally functioning joint, this surface is smoother than ice on ice. Imagine that for a moment. Ice on ice. The good Lord is one heck of an engineer.
But when the cartilage is lost, it does not return- and the surface more closely resembles sandpaper. At this point, in the parlance of the car mechanic: “your bearing is shot.”
There are actually over 100 types of arthritis and many can affect the GH joint. Inflammatory arthritis (rheumatoid), osteoarthritis, and post trauma arthritis are the most common types.
The bottom line is that all arthritis leads down the same rough road: breakdown of smooth joint cartilage and exposure of the bony undersurface. Additionally bone spurs tend to pile up on the joint, usually at the bottom of the ball. Think of the bone spurs as your body’s way of trying to get you to stop moving the joint: they build overtime and start to slowly lock up your movement. That’s why, if you have bad GH arthritis, you probably have significant stiffness as well as pain. This is a case when bone spurs really ARE a problem.
GH arthritis usually develops slowly over time. It’s not uncommon for me to see a patient with end stage GH arthritis who has had shoulder pain for 10 years. Of course timing of onset depends on the root cause. Unfortunately posttraumatic arthritis may advance more quickly depending on the specific circumstances.
Treatment options really depend on how advanced your arthritis is.
Cortisone injections can buy you time. But they don’t cure arthritis. They help reduce inflammation and pain because they are placed at the point of inflammation. Risks are relatively low but not zero.
Oral medications such as anti inflammatories may be an option as well. But you must always consider potential drug reactions with other medications you may be taking, side effects such as stomach irritation and proper dosing.
I tend not to prescribe physical therapy for GH arthritis: it might help your motion somewhat, but it’s often painful and not worth the marginal gain if you have severe arthritis. If you want to try therapy and can tolerate it, gentle stretches are your best option. I’ve had a few patients, one a painter and the other a yoga instructor who maintained amazing range of motion with really advanced arthritis. I think it was due to the fact that their job forced them to constantly stretch their shoulders. But it’s hard to expect that level of commitment from folks that don’t make their living off of constant shoulder motion.
There are some time tested and reliable surgical treatments for GH arthritis. The decision to pursue surgery however is a personal and subjective one. Everyone has a different threshold at which the pain gets unmanageable.
Dr. DiPaola is one of a small percentage of orthopedic surgeons in the country that treats glenohumeral shoulder arthritis regularly. If you’ve been diagnosed with shoulder arthritis and are considering treatment options please contact us for more information or a personal consultation.