Orthopaedic Surgeon
Shoulder Arthritis
What is shoulder arthritis?
Are joints are able to move so well because the articular surface is lined with a tissue known as cartilage. This cartilage is extremely smooth and has very little friction, like ice-on-ice. As we get older, the cartilage begins to wear down. Damage and loss of cartilage leads to joint arthritis.
There are many different causes of joint arthritis. We typically think of biology of the joint as a main factor in the development of arthritis. There is also a component of previous trauma or repetitive activities that can lead to joint wear.
What causes shoulder arthritis?
How is shoulder arthritis treated?
Shoulder arthritis can be a difficult condition to treat. We try to maximize nonoperative interventions first. Patients can benefit from physical therapy, NSAIDs, activity modification, and rest. We can also perform steroid injections which can provide great temporary relief to the shoulder pain. If the shoulder pain limits the ability to do the activities the patient wants to do and is a significant burden on their quality of life they may benefit from a shoulder replacement. This surgery removes the diseased and damaged cartilage and bone of the joint and puts a metal and plastic joint in its place. A shoulder replacement is not a new biologic shoulder--it is still metal and plastic. The procedure is mainly to relieve pain but some patients notice an improvement in range of motion and function as well.
The image on the left demonstrates a normal shoulder joint. Cartilage does not show up on an xray, therefore, the joint space is well preserved. The image on the right demonstrates severe shoulder arthritis. Note that the joint space is no longer present between the humerus and scapula. Images courtesy of Dr. Skelley.
ARTHRITIC JOINT
NORMAL JOINT
Recovery from a shoulder replacement is a long process. It can take between 6 months and 1 year to return to most activities. Most patient note immediate relief from the arthritic pain, but it can take several weeks to months to recover from the surgical pain. You will return for approximately 5 visits in the postoperative period and will meet regularly with a physical therapist during your rehabilitation.
What is the recovery from a replacement?
Total Shoulder Replacement
Reverse Total Shoulder Replacement
The image on the left demonstrates an anatomic total shoulder replacement. The shoulder on the right is a reverse total shoulder and is performed in certain unique situations of shoulder arthritis. Images courtesy of Dr. Skelley.
References
1. Skelley NW, Namdari S, Yamaguchi K. Alternatives to Total Shoulder Arthroplasty for the Young, Active Patient. Paris International Shoulder Course. February 2013.
2. Skelley, NW, Namdari, S., Chamberlain, A., Keener, J., Galatz, L., and Yamaguchi, K. Arthroscopic Debridement and Capsular Release for the Treatment of Shoulder Osteoarthritis. Arthroscopy. November 2014. doi:10.1016/j.arthro.2014.08.025
3. Skelley, NW “Treatment of Athletes with Shoulder Arthritis.” Presented at: Massachusetts General Hospital Sports Medicine Grand Rounds; Boston, MA. November 2016.