Shoulder Arthritis

What shoulder arthritis is

The shoulder is built for reach rather than for weight bearing. Its main joint is a shallow ball and socket in which the head of the upper arm bone moves against a small, dish shaped surface on the shoulder blade. A second joint, where the collarbone meets the acromion, sits on top and can wear out on its own. Both surfaces are lined with articular cartilage, which lets bone glide on bone almost without friction. Arthritis is the general term for loss or inflammation of that lining.

Several processes can produce it. Osteoarthritis is the gradual wear and tear pattern, in which cartilage thins and bone spurs may form around the rim. Inflammatory arthritis, such as rheumatoid arthritis, attacks the joint lining itself. Arthritis can also follow an old fracture or dislocation, or develop when a long standing rotator cuff problem changes how the ball sits in the socket. Because the shoulder does not carry body weight, symptoms can stay quiet and then become noticeable when the arm is asked to work overhead.

Symptoms that often bring people in

• A deep, aching pain in the shoulder or upper arm that is worse with activity.
• Grinding, clicking or catching as the arm is rotated.
• Stiffness that makes it hard to reach overhead, behind the back or across the body.
• Pain at night, particularly when lying on the affected side.
• Weakness, or an arm that tires quickly during ordinary tasks.

How it is evaluated

Evaluation begins with your account of how the shoulder behaves: where the pain sits, what provokes it, and whether there was a past injury. Examination compares both shoulders and looks at active motion, which you produce yourself, and passive motion, which the examiner produces for you, since the difference helps separate a stiff joint from a weak one. Rotator cuff strength and the neck are usually assessed at the same visit, because neck problems can send pain into the shoulder. Plain X-rays in several specific views show cartilage space, spur formation and the position of the humeral head, and CT or MRI may be discussed to assess bone shape or the rotator cuff in more detail.

Treatment options in general terms

Non-surgical care is generally considered first, and for many people it forms the whole of treatment.

• Activity adjustment. Changing how loads are lifted so the joint does less of what irritates it.
• Physical therapy. A guided program aimed at maintaining motion and supporting the shoulder with the surrounding muscles.
• Medication categories. Anti-inflammatory and pain relieving options a physician may discuss alongside your other conditions.
• Injections. Corticosteroid injections are used in some cases, and biologic options such as platelet rich plasma may be discussed for selected situations.

If symptoms persist and imaging shows structural change, surgical options may be raised. Which applies depends entirely on the individual shoulder.

• Arthroscopic joint preservation. Small instruments used through short incisions to address inflamed lining, loose fragments, scar tissue or spurs where cartilage is not extensively lost.
• Shoulder arthroplasty. Replacement of the worn surfaces with an implant. Anatomic and reverse configurations exist, and the choice is influenced by the rotator cuff and the shape of the socket.

What to expect when you consult Dr. Wolfson

Dr. Wolfson, MD, FRCSC, FACS, is board certified in the United States and in Canada. A consultation begins with how the shoulder limits your day rather than with a decision about surgery. He will examine the joint, review or arrange imaging, and explain the findings in plain language.

This page provides general information about shoulder arthritis and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]