Glenohumeral Arthritis
Anatomy:
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff.
Types/Causes of Arthritis:
| Osteoarthritis | Also known as "wear-and-tear" arthritis, osteoarthritis is a condition that destroys the smooth outer covering (articular cartilage) of bone. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. During movement, the bones of the joint rub against each other, causing pain. |
| Rheumatoid Arthritis | Rheumatoid arthritis (RA) is a chronic disease that attacks multiple joints throughout the body. The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move. Rheumatoid arthritis causes the lining to swell, which causes pain and stiffness in the joint. Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. |
| Post-traumatic Arthritis | Posttraumatic arthritis is a form of osteoarthritis that develops after an injury, such as a fracture or dislocation of the shoulder. |
| Avascular Necrosis |
Avascular necrosis (AVN) of the shoulder is a painful condition that occurs when the blood supply to the head of the humerus is disrupted. Because bone cells die without a blood supply, AVN can ultimately lead to destruction of the shoulder joint and arthritis. Causes of AVN include high-dose steroid use, heavy alcohol consumption, sickle cell disease, and traumatic injury, such as fractures of the shoulder. In some cases, no cause can be identified; this is referred to as idiopathic AVN. |
Imaging:
Typically, x-rays are adequate for diagnosing glenohumeral arthritis, but sometimes a CT scan is necessary to understand the extent. X-rays will typically show a narrowing of the joint space, changes in the bone, and the formation of bone spurs (osteophytes).
Treatment:
Nonsurgical Treatment
As with other arthritic conditions, initial treatment of arthritis of the shoulder is nonsurgical. Your doctor may recommend the following treatment options:
- Rest or modifying your activities to avoid aggravation of symptoms.
- Physical therapy exercises to try and improve the range of motion in your shoulder.
- Nonsteroidal anti-inflammatory medications (NSAIDs), such as Aleve or ibuprofen, to reduce inflammation and pain.
- Corticosteroid injections in the shoulder can dramatically reduce the inflammation and pain. However, the effect is often temporary.
- Heat and/or ice for 20-30 minutes at a time.
Surgical Treatment
When nonsurgical treatment is unsuccessful, a shoulder replacement (arthroplasty) may be the best option to relieve your arthritis symptoms. The damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis. If this is needed, Dr. Fleager will refer you to one of her partners that sub-specializes in shoulder replacements.
Replacement surgery options include:
- Total shoulder arthroplasty: Both the head of the humerus and the glenoid are replaced. A plastic "cup" is fitted into the glenoid, and a metal "ball" is attached to the top of the humerus.
- Reverse total shoulder arthroplasty: In a reverse total shoulder replacement, the socket and metal ball are opposite a conventional total shoulder arthroplasty. The metal ball is fixed to the glenoid and the plastic cup is fixed to the upper end of the humerus. A reverse total shoulder replacement works better for people with rotator cuff tear arthropathy because it relies on different muscles — the deltoid, not the rotator cuff — to move the arm.
- Recovery: You will spend at least one night in the hospital in order to closely monitor your status and provide great care after surgery. Typically, you will wear a sling for 4 weeks to avoid any shoulder range of motion. It is okay to perform elbow/wrist/hand range of motion during this time.
- Physical therapy: You will participate in physical therapy for approximately 8-12 to improve shoulder range of motion and strength.