In the normal shoulder (glenohumeral joint), motion occurs between the humeral head and the glenoid which both have smooth surfaces lined with cartilage. As seen on the X-ray above, the normal shoulder has smooth curvatures with a symmetrical joint space created by the cartilage lining overlying the humeral head and glenoid.
Arthritis of the shoulder develops when the normal smooth cartilage has become worn away. This results in a rough surface at the ball and socket joint, creating painful and sometimes reduced range of motion of the shoulder. The joint space seen in the above X-rays shows this decrease in joint space which may eventually worsen to the point where bone on bone contact occurs. Bone spurs may also develop during this process as the bone reacts to increased stress. The arthritic shoulder becomes inflamed resulting in pain during activity or even at rest.
As shoulder arthritis develops, patients experience pain that typically worsens gradually with time, increases with activities, and may interfere with sleep. Range of motion decreases, and atrophy (wasting) of the muscles around the shoulder worsens. The shoulder may swell and exhibit mechanical symptoms such as grinding, clicking, and popping. Eventually, activities of daily living are affected, as patients have difficulty with dressing, grooming, bathing, and even eating.
Non-operative treatments are used initially and consist of activity modification, anti-inflammatory medications, cortisone injections, and sometimes physical therapy. The goal of physical therapy is to attempt to maintain range of motion and prevent further stiffness of the shoulder. Strengthening exercises and excessive stretching, however, can be painful.
Patients with shoulder arthritis have two surgical options: arthroscopic debridement or shoulder replacement. Arthroscopic surgery does not reverse the arthritic process, but often has the ability to provide pain relief for a period of time. Shoulder replacement surgery is the most reliable surgery for improving pain and returning function for the arthritic shoulder.
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