Did you know that shoulder arthritis has a variety of causes? This condition doesn't just affect the elderly, but it can affect young people too.
We got in contact with Mr Jagwant Singh , one of the consultant shoulder and elbow surgeons based in London, to discuss how this condition should be managed. We also learnt about how both non-surgical and surgical treatment can be effective.
What are the main causes of shoulder arthritis?
Arthritis means damage to the cartilage. The cartilage is the layer of padding that covers joints to allow smooth movement and absorbs shock. The initial pain in arthritis is due to inflammation, followed by pain coming from mechanical friction of raw bones rubbing against each other.
The shoulder joint comprises of the humeral head (ball), the glenoid (socket). Above the shoulder joint, there is another joint between collar bone (Clavicle), and shoulder blade (Scapula). This is known as Acromio-clavicular (AC) Joint. Shoulder arthritis occurs when the cartilage protecting the bigger ball-and-socket joint deteriorates. This could be due to:
- Osteoarthritis, that mainly develops in elderly.
- Trauma, fractures, dislocations, rotator cuff tears and shoulder instability, that mainly occurs in younger people (under 70 years old).
- Other causes include rheumatoid arthritis, an autoimmune disease; post-traumatic arthritis; disrupted blood supply (Avascular necrosis).
What treatments or medication can a consultant offer?
Before any treatment, the consultant specialist starts with an assessment of the shoulder. It is important to consider the history and other factors, such as previous injuries. A correct diagnosis is needed before correct treatment can be started. Focussed examination, followed by relevant imaging of shoulder joint, is needed to confirm the diagnosis.
Shoulder pain and symptoms have different causation in different age groups. In the earlier years, it could be caused by instability, rotator cuff problems, frozen shoulder syndrome, and biceps pathology. As there are various potential causes, it's important that a correct diagnosis is made. Investigations such as MRI scans help in making a diagnosis, and ultimately, in guiding treatment to relieve symptoms and improve function.
Over the counter analgesics, physiotherapy, and steroid injections have a role. Treatment plans should be tailored for patients. This includes surgical and non-surgical options. Appropriate rehabilitation is also important.
Exercise has a role in maintaining muscle strength and reducing pain. It doesn't reverse the degeneration process that has already set in but certain lifestyle choices have shown to ease pain and progression of arthritis, in addition to improving quality of life.
When would surgery be necessary?
If medications, physiotherapy, and injections do not relieve pain, then surgical intervention would be recommended. Most of the time, early shoulder arthritis can be managed with injections and physiotherapy. However, if there is advanced arthritis, or if there is a structural problem in the shoulder joint that generates pain, for example massive rotator cuff tears, then that may need surgery.
Cartilage tears and frayed biceps tendon are pain generators. Sometimes, osteophytes (bony lumps) can grow as a response, which can cause pain. If the arthritis has progressed to a severe stage, then joint replacement to control symptoms and improve function may be needed.
AC Joint arthritis is different. The treatment for severe pain is simply excision of end of collar bone. This can be done via a key hole or open surgery. This provides excellent pain relief without compromising function.
What type of surgery is performed?
Keyhole surgery offers the benefit of preserving the native shoulder joint. Comprehensive Arthroscopic Management (CAM), includes a combination of keyhole procedures, which address pain generators, and facilitate cartilage growth. This may include a technique called Microfracture, where small holes are made in the bone to stimulate a type of cartilage to form, covering the exposed bone. It can reduce pain and restore function in certain cases. CAM has been found to be very effective for active young patients, who are not ready for a joint replacement.
Subacromial balloon arthroplasty involves keyhole surgery. A balloon spacer is inserted in cases where rotator cuff tears are massive and irreparable. This has shown to improve the biomechanics of shoulder joint and reduce pain.
Multiple options of joint replacement are available, total or partial. 'Total' includes replacement of humeral head (ball) and glenoid socket. Those who have had rotator cuff tears that has led to arthritis may need a 'reverse total shoulder replacement'. This is where both the ball and socket are replaced, but the ball is placed on the socket side and vice versa. This is needed, as the rotator cuff tendon is no longer present to keep the ball centralised in the socket. Reversing the “polarity” of the joint allows stability of the new artificial components.
What are the latest advancements?
There are advancements in both hardware and software.
We have the option of using stemless or short stem humeral components, which are bone conserving. They allow for easier revision surgery in the future.
Some patient have eroded significant amount of bone from the socket. This has always been a challenging problem. Bone and metal augments are now available to build up the socket and help correct the deformity during replacement.
Planning software, navigation and patient-specific instrumentation are available to help perform the shoulder replacement. This allows us to plan and navigate the shoulder replacement surgery. It has shown to improve precision, provide better patient outcomes, and implant longevity.
We now have the technology for real-time navigation during shoulder replacement surgery. Mixed reality, Artificial Intelligence (AI), and augmented reality have all been used to help surgeons perform procedures with precision and accuracy. The future is quite promising with all these innovations.
For personalised treatment for shoulder arthritis, we recommend getting in contact with an expert such as Mr Jagwant Singh, a leading trauma and upper limb consultant orthopaedic surgeon. Click here to visit his profile today for information on appointment availability.