A shoulder dislocation puts you at risk for developing osteoarthritis of the shoulder later on in life.
Not to worry if this happened to you as a young adult while playing sports, or more recently from a slip and fall injury. Many Americans suffer from shoulder arthritis but very few actually require a joint replacement. The frequency of shoulder replacements in the US is one-tenth the number of hip replacements or knee replacements performed annually. Because we don’t walk on all fours, we tolerate and compensate for an arthritic shoulder much longer than an arthritic hip or knee.
Shoulder arthritis: What are the signs?
Many patients who develop arthritis in their shoulder note a slow and subtle loss of motion. This occurs progressively over time and is usually painless.
The first signs are difficulty reaching behind your back to wash your back or do other activities of daily living, such as hooking a bra. Early arthritis patients are easily able to treat intermittent flare-ups of pain with over-the-counter pain medications or anti-inflammatory medication. Patients typically use these medications and treatments for two-to-three weeks and then the shoulder returns to baseline.
If you have noted these symptoms and have a history of shoulder dislocation, then you may be developing shoulder arthritis.
Shoulder arthritis: how to treat it?
Treatments that you can do on your own include stretching and strengthening regimens that do not require formal visits to a physical therapist. However, you may wish to see a physical therapist or an athletic trainer for an evaluation and recommendations on a home-based treatment program.
Stretching exercises performed daily can help prevent stiffening of the shoulder, which can be a source of pain. Gentle strengthening exercises of the muscles around your shoulder blade and shoulder girdle help prevent pain and flare-ups and maintain upper extremity function. Many people find yoga exercises, tai chi exercises, and basic exercises with light dumbbells to be very helpful.
When does shoulder arthritis become moderate to severe?
If you develop squeaking of your shoulder as you rotate your arm at waist level, or if you note crunching or clunking with these motions, then the arthritic change has progressed beyond mild and has moved into the moderate to severe category.
This still does not necessarily mean that you need a shoulder replacement. Continuing a pain-free exercise program is very beneficial at prolonging the life of your shoulder. That said, there may come a time when you are unable to control pain with simple anti-inflammatory medications and exercise.
At this point, additional non-operative treatments are available. This includes corticosteroid injections, which help alleviate symptoms, sometimes for a prolonged period of time.
When is surgery an option?
In the event that corticosteroid injections do not provide adequate relief, arthroscopic surgery might be the right option.
A shoulder arthroscopy for arthritis entails:
- Removing loose bodies (small free floating pieces of bone and cartilage – like a rock in your shoe).
- Cleaning up your arthritic joint and any degenerative tears to the soft tissues around the shoulder.
- Possibly removing the biceps tendon from the inside of shoulder joint.
The biceps tendon can be significant pain generator, especially when it becomes partially torn, thickened and degenerative as a result of the arthritic change in the shoulder.
When is shoulder replacement surgery an option?
If you are not a candidate for this procedure, then you might consider a shoulder replacement. This kind of operation is rather uncommon,. You may have spoken with patients who had other types of shoulder surgery – for example, a rotator cuff repair. Such patients may have had a very difficult time with postoperative rehabilitation.
Shoulder replacement surgery is a different operation from rotator cuff repair surgery and the rehabilitation process is not the same. In addition, the postoperative recovery is completely different, and unlike rotator cuff repair surgery, shoulder replacement is relatively pain-free once the incisional pain is gone. Because the arthritic joint, which is the major source of pain in the shoulder, is replaced, patients feel great relief after the operation. Usually, an overnight stay in the hospital is required, but most patients do go home the following day.
Adam Shafritz, MD, is an Upper Extremity Surgeon at the University of Vermont Medical Center and an Associate Professor at the Larner College of Medicine at UVM. Watch a short video interview with Dr. Shafritz.