Shoulder Arthritis
What is Internal Impingement?
ach shoulder is made up of three joints. These joints work together to help the shoulder move. The largest of these joints is a ball and socket joint. The “ball” is formed by the top of the upper arm bone, which glides around on a “socket”, which is part of the shoulder blade.
There are different causes of arthritis, mainly ‘wear & tear’, injury, inflammatory arthritis (like rheumatoid), previous injury or surgery of the shoulder.
This can result in pain. You can have a stiff shoulder that grinds or clunks. This can lead to a loss of strength, decreased range of motion in the shoulder and impaired function
What Causes it?
The most common cause is usually wear and tear due to aging process of wear of cartilage because of different reasons
Osteoarthritis: (OA)
It is also known as “wear-and-tear” arthritis. In osteoarthritis is a condition that destroys the smooth lining (articular cartilage) of bone. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. During movement, the bones of the joint rub against each other, causing pain.
OA usually affects people over 50 years of age.
Rheumatoid Arthritis: (RA)
The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move. Rheumatoid arthritis causes the lining to swell, which causes pain and stiffness in the joint. RA is a chronic disease that attacks multiple joints throughout the body. Often the rotator cuff can also be damaged in patients with RA
Post Traumatic Arthritis: (PTA)
This usually follows injury to the shoulder joint causing damage to the cartilage. It may occur after an initial fracture repair has been attempted.
Cuff Tear Arthropathy: (CTA)
This is usually the consequence of untreated rotator cuff tear. Over a long period of time the cuff cannot hold the ball of the arm down and it rubs against the shoulder blade and collar bone leading to arthritis in the shoulder joint.
Avascular Necrosis: (AVN)
This is uncommon in shoulder joint compared to hip joint but can follow either trauma, infection, alcohol abuse or steroid use.
How is it diagnosed?
Shoulder arthritis is usually diagnosed on a careful clinical examination and supported by confirmation with plain radiographs.
Investigations:
X-Ray is used to confirm the diagnosis of osteoarthritis. You may also require a CT scan or MRI scan as part of per operative planning which helps the surgeons and team to plan the operation and also advise the appropriate type of prosthesis.
Treatment:
- Conservative treatment comprising of rest, activity modification and non-steroidal anti-inflammatory may be helpful in the early stages and when symptoms are mild.
- Physiotherapy: A rehabilitation programme directed by a physical or occupational therapist may be helpful in stretching the joint and preventing the loss of movements. The success depends on the level of pain and expectations.
- Dietary supplements, such as glucosamine and chondroitin sulfate
- Injections: An ultrasound or fluoroscopy guided injection in the AC joint provides a decrease in inflammation and reduces pain. Cortisone’s effects are often temporary, but it can give very effective relief in the short term. It also aids in confirming the diagnosis.
Surgical Treatment
If nonsurgical treatment does not reduce pain, there are surgical options.
Arthroscopic: Key hole treatment of the shoulder for osteoarthritis is primarily a temporary therapy in which the joint is “tidied up.” The surgeon removes unwanted material and smoothes off the joint, hopefully providing relief of symptoms.
Arthroscopic Cartilage Regrowth:
In small number of cases Prof. Singh offers cartilage regrowth. This is called the Mesenchymal Cells Induced Chrondrogenesis (MCIC) where in bone marrow cells from patient’s iliac crest are used to facilitate cartilage regrowth.
Shoulder Replacement: Traditionally the three forms of replacement that have been used are:
- Hemiarthroplasty
- Total shoulder arthroplasty.
- Reverse Shoulder Arthroplasty
Hemiarthroplasty involves a prosthetic metal implant being placed into the upper bone in the arm – the ball which forms half of the shoulder joint.
In total shoulder arthroplasty both sides of the joint are replaced – the ball and socket. An alternative joint reconstruction is humeral head resurfacing. In this procedure, a small amount of the affected bone is removed from the humeral articulating surface (head) and replaced by a smooth metal cap.