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Shoulder Arthritis

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Shoulder Arthritis

Shoulder Arthritis 

Shoulder arthritis happens when the cartilage inside the shoulder joint is damaged. The shoulder area has two joints – shoulder arthritis usually refers to the glenohumeral joint which connects the two bones called the glenoid and humerus. The second joint in the shoulder called the acromioclavicular or AC joint can also develop arthritis known as AC joint arthritis.

 

 

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Types of Shoulder Arthritis

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Osteoarthritis of the Shoulder

This is often associated with the wear and tear of joints related to ageing or overuse disorder. The synovial fluid (lubricant) of the glenohumeral joint has dried up and the cartilage of the articulating surfaces is damaged, resulting in ulcers within the cartilage surfaces, allowing friction upon the bone rubbing bone from the humerus and the scapulae and thereby causing intense inflammation and bone oedema (i.e. Arthritis).

Rheumatoid Arthritis of the Shoulder

Rheumatoid arthritis is an autoimmune disorder. Once the immune system has been overly sensitised, it no longer serves as a protective defence function but causes aggravated attacks on the joints of the body, failing to recognise them as its own. This results in inflammation and swelling of the joints namely: wrist, fingers, shoulders, and knees. It is possible to have both shoulders affected by this inflammatory arthritis.

Post Traumatic Shoulder Arthritis

Post-traumatic arthritis may develop if your shoulder is fractured, dislocated, or injured in any way.

Rotator Cuff Tear Arthropathy

Rotator cuff tear arthropathy is a type of shoulder arthritis that develops after a massive and prolonged rotator cuff tear. Four tendons connect the shoulder ball to the rotator cuff, supplying the shoulder joint with mobility. When any of these tendons are severely torn, the humeral head can rub against other bones and cause arthritis.

Avascular Necrosis

Avascular necrosis occurs when the blood supply to a particular area of the body is disrupted, resulting in that region dying (necrosis).

Symptoms of Shoulder Arthritis

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Pain in the shoulder joint

The most common description of shoulder arthritis is a pain in the shoulder joint that can be present in the front, side or back of the shoulder. The pain can occur at any time of the day and can be present with or without shoulder stiffness. It often presents as movement-related pain.  It may start off as morning pain and stiffness.  The pain often becomes worse when lifting, carrying heavy objects or after exercising. It may also radiate into the arms or radiate down to the elbow and wrist.

Stiffness

This is a sign of progression of shoulder arthritis. You may experience stiffness as a loss of range of motion in the shoulder. It may restrict movements such as lifting the arm over the head or rotating the shoulder to the back to hook the bra.

Grinding, clicking or cracking

You may feel a clicking, grinding, or cracking sensation in the shoulder area which may or may not be painful. This is likened to loss of lubrication within the shoulder joint.

 

A Message About Shoulder Arthritis

Shoulder arthritis pain has many similarities to knee arthritis pain. Its pain is movement-related. Rest pain though infrequent may present as night pain when lying on the affected shoulder. It has all the hallmarks of arthritis inflammation: Pain, Warmth, Redness, Swelling, and stiffness with loss of movement. Its pathology is synovial fluid dries up, increasing friction between cartilage surfaces, exposing the risk of cartilage loss and ulcer formation. Once the underlying bone develops bony swelling and oedema, it is irreversible and will develop deformity of the head of the humerus. Fortunately, it is not a weight-bearing joint, hence it is not as common as arthritis of the knee or hip.
Early-stage and moderate shoulder arthritis can be treated with specialised injections without the need for surgical interventions. Only in late-stage shoulder arthritis, there may be a consideration of total shoulder replacement with metal implants.

Diagnosing Shoulder Arthritis

Here at Singapore Paincare, our team of experienced primary care physicians and pain care specialists together with an orthopedic surgeon will evaluate your condition. This includes a physical exam, asking questions about your symptoms, and evaluating your medical history. An X-ray, CT scan, and/or MRI scan may be needed to evaluate or confirm the degree of the shoulder arthritis and prognosticate the severity of the disease.

What Treatments Are Available for Shoulder Arthritis?

At Singapore Paincare, we strive to treat your pain with the least invasive option possible after accurately identifying the cause. Our approach to pain resolution focuses on the removal of pain generators via specialised injection and minimally invasive procedures. Combined with pharmacological treatments and cognitive and physical rehabilitative therapies – we help patients improve functions and prevent pain from recurring.

 

Non-surgical Treatments for Shoulder Arthritis

 

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Platelet Rich Plasma (PRP) Injection

In osteoarthritis of the shoulder, apart from the joint destruction, there are associated surrounding ligament injuries and damage, and the latest medical method is to inject platelets, which can help in healing. Platelet injections are commonly used for pain caused by a torn meniscus as well as conditions such as osteoarthritis. The injection sites may include the surrounding tendons and ligaments.

Gel Injections

Intra-articular Artificial lubricants injections are used to ease the movement of the joints and frictions. Specialised injections into the glenohumeral joint can be done safely and effectively via surface landmarks and/or the use of ultrasound guidance. Once the needle enters the joint, the lubricant gel will be administered intra-articularly. There are different types of gels ranging from low to high molecular weight. The selection of the type of hyaluronic acid is dependent on the patient’s conditions. Additionally, other injections such as non-steroidal anti-inflammatory drugs and anaesthetics can also be injected around the shoulder ligaments for pain relief.

Physical Therapy

The therapy sessions by our specialists involve resistance training to reduce pain, however, the intensity and type of exercise may differ based on the conditions of the patient.

Medications

Nonsteroidal anti-inflammatory drugs (NSAID) are prescribed to treat pain conditions such as shoulder arthritis.  

Surgical Treatments for Shoulder Arthritis

Surgery is an option for intractable painful shoulder arthritis, this is done after careful consideration to see if you are suitable for the procedure. As surgery always comes with associated risks, complications, and downtime – it may not be suitable for everyone. You should carefully weigh your decision before deciding to go under the knife by considering the pros and cons of both non-surgical methods and surgical reconstruction.

If you choose to have surgery, your options may include:

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Arthroscopy

Arthroscopy is an alternative minimally invasive procedure to access and treat the joints in the shoulder. The process uses a camera to view the affected region, allowing the doctors to make precise removal of ligaments or fluid as necessary. Through the scope, repair of tendons may be possible without the need for large surgical wound.

Shoulder Joint Replacement Surgery

If all other options did not provide relief, doctors may recommend a replacement of the damaged sections of the shoulder with an artificial component. However, this is only done as the last resort or if the patient is a suitable candidate for surgery.

 

How Can I Prevent Shoulder Arthritis?

Some forms of shoulder arthritis cannot be prevented. However, maintaining a proper posture, exercising regularly and having a healthy diet will help with your overall health. While everyone may develop wear and tear of the shoulder joint, we can keep the inflammation away. As one ages, you may have a degenerated shoulder joint, but not necessarily arthritis of the shoulder.

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