Shoulder Arthritis

Shoulder Arthritis is the loss of the cartilage cushion in the joint surfaces (blue section) that allows the smooth pain free gliding required during shoulder motion.

Pathology


Shoulder Degenerative Arthritis Shoulder Avascular Necrosis

Shoulder Arthritis is the loss of the cartilage cushion in the joint surfaces (blue section in above illustration) allowing the smooth pain-free gliding required during shoulder motion. This can affect all three joints of the shoulder:

  • Glenohumeral (GH)
  • Sternoclavicular (SC)
  • Acromioclavicular (AC)

Symptoms of Developing Shoulder Arthritis

  • Shoulder pain present during all activities, especially reaching overhead and leaning on shoulder
  • Crepitance: a grinding noise accompanying shoulder movement
  • Decreased range of motion in shoulder
  • Overall limited function of shoulder

Types of Shoulder Arthritis

  • Osteoarthritis or degenerative – Results from wear and tear over time due to aging
  • Post-traumatic – Occurs when a fracture or broken bone extends into the joint and heals improperly. Repeated joint dislocations injure the joint cartilage

Causes of Shoulder Arthritis

  • Genetics – Arthritis occurring at a younger age (under 40 years old) is rare and is commonly due to inherited genetics.
  • Shoulder infection
  • Avascular Necrosis (AVN) – When there is loss of blood supply to the humeral head (top of the arm bone), the humeral head collapses and becomes arthritic. Cause of AVN include:
  • Excessive use of steroids
  • Sickle Cell disease
  • Prolonged deep-sea diving
  • Other systemic conditions
  • Gout or pseudo – gout – Various crystals in the shoulder joint (called gout or pseudo gout) cause inflammatory cells in the body to attempt to clean up the invading particles. In the cleaning process, the cells inadvertently destroy both themselves and the joint surfaces.
  • Inflammatory conditions include: Rheumatoid arthritis, Lupus, Psoriatic arthritis

Treatment

Shoulder Arthritis Treatment Options

  • Joint resurfacing procedure
  • Joint replacement (shoulder arthroplasty)

Questions to Define a Patients Shoulder Joint Arthritis

  • Does the arthritis affect one side of the joint or both sides?
  • Is the rotator cuff intact and functional?
  • What is the age of the patient and the activity demands requested of the joint replacement?
  • What is the quality of the bone available?

The answers to these questions allow for selection of the procedure that resects the least bone but still gives the best possible result without compromising future treatment options.

A total shoulder replacement is done when both sides of the joint have arthritis and both the humeral head and glenoid surface is replaced.

A reverse shoulder replacement is performed when there is arthritis in the shoulder joint combined with a massive unrepairable rotator cuff tear.

Shoulder implants are used for shoulder replacements. There are many implants available and the surgeon will select an implant based on their experience and with the goal of a reliable result, based on the reported outcomes in the orthopedic literature.

Examples of the different shoulder arthroplasties are shown below.


Resurfacing Hemi-arthroplasty for Humeral Head AVN referred to as a Cap


Total Shoulder Arthrplasty for arthritis on both sides of the joint


Reverse Total Shoulder Arthroplasty for arthritis on both sides of the joint & no rotator cuff Function