Treatment for arthritis in the shoulder
How is shoulder arthritis treated?
Many times, people suffering from chronic shoulder pain find it helpful to know the cause of their pain. Being in constant pain is not pleasant and it can be very easy to start worrying about what could be causing it. Sometimes, a diagnosis of shoulder arthritis is actually a relief to people, as they at least know what they are dealing with rather than continuing to experience uncertainty.
There are a number of ways arthritis in the shoulder can be treated and managed, ranging from ‘do it yourself pain relief’ all the way through to shoulder replacement surgery. We will look at the available treatments under two headings, ‘non-surgical’ and ‘surgical’.
Non-surgical treatments for shoulder arthritis
There is a range of non-surgical treatment options for arthritis in the shoulder, and these are most helpful at different stages of arthritis progression.
- Analgesia: this is the medical term for pain relief. There are many medicines available that help to relieve pain, but before taking any medicine, you should ensure it is safe for you to do so. If you are unsure, you should consult a medical professional such as a doctor or pharmacist.
In the early stages of shoulder arthritis, an over-the-counter painkiller such as paracetamol can help to manage any pain sufficiently. As the arthritis develops, the pain relief you get from paracetamol may decrease, and your doctor may suggest using a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen. As well as reducing pain, these can also help to reduce inflammation. Some NSAIDS can be purchased over the counter from your local pharmacy, while others will need a prescription.
- Activity modification: Altering the way you use your shoulder for common, everyday tasks may help to reduce the pain you feel. This is known as ‘activity modification’. A keen tennis player may change their stroke, serving or returning the ball underarm rather than overarm, as this puts less stress on the shoulder joint. A swimmer may change their stroke from front crawl, which is heavily dependent on shoulder movement, to breaststroke, with its gentler shoulder movements.
The aim of modifying activities in this way is to help manage the symptoms of arthritis in the shoulder. It is not a ‘treatment’ as such, but it can be a practical way of limiting further pain due to overuse of the shoulder joint.
- Physiotherapy: Expert guidance from a physiotherapist can help strengthen the muscles in your shoulder joint, back and arm to compensate for the effects of arthritis. Physiotherapy may help you to maintain function and mobility in the shoulder for longer than would otherwise be achieve, which can help to delay the need for shoulder surgery to treat severe arthritis.
The Circle physiotherapy team will work closely with your consultant and other healthcare professionals to structure a custom exercise plan for you to help keep you as mobile and active as possible, for as long as possible.
- Exercise: While shoulder arthritis causes pain and stiffness in the joint, it is important that you continue to use your shoulder. There will be limits to what you can do safely and without causing further pain, but movement and exercise is beneficial for long-term health and mobility. Swimming is a particularly good form of exercise for people with arthritis in the shoulder, as the buoyancy and support provided by the water reduces the stress (also known as the ‘load’) placed on the joint.
- Steroid injections: As arthritis progresses in the shoulder joint, pain and stiffness usually also become worse, with painkillers having less of an effect in managing the pain. Steroid injections (also known as ‘corticosteroid injections’) can be of help in this instance. These anti-inflammatory medicines help to reduce swelling in the joint and the surrounding area, reducing pain and stiffness.
These injections will be given by your shoulder doctor at Circle, often using ultrasound to ensure the injection is in the correct place. It will usually take a few days before you start to feel the full effects of the treatment. The effects are fairly short-term, lasting for a month or two before wearing off. Steroid injections can be repeated, although most people find that they become less effective over time.
Surgical treatments for shoulder arthritis
When shoulder arthritis progresses to the extent it is no longer being successfully managed by non-surgical means, your doctor may talk with you about the possibility of surgery on your shoulder. There are a number of different surgical options available, and a discussion with your doctor is the best way to determine if surgery is appropriate for you, and which surgical procedure would provide you with the greatest benefit.
- Arthroscopic surgery: This is a form of keyhole surgery, so called because it only uses small cuts to access the joint, unlike traditional “open” surgery when larger cuts are made to open up the joint completely. Arthroscopic surgery of the shoulder is normally done under general anaesthetic, meaning you are asleep during it. This has a double benefit of keeping you pain-free while also relaxing the muscles around the shoulder during the operation.
During the surgery, a thin metal tube about the size of a pencil, is placed into your shoulder joint through a small cut. This tube is known as an arthroscope and has a light and camera on one end, allowing the surgeon to clearly see inside the joint itself. Additional small surgical tools can be introduced into the joint to help the surgeon clear out any floating bone fragments (known as ‘bone spurs’) and to smooth out or ‘trim’ the articular cartilage on the ends of the bones to relieve friction when the bones move against one another.
- Total shoulder replacement surgery: Should the arthritis in your shoulder joint develop to the point you are in constant discomfort and have extremely limited movement, a shoulder replacement may be advised as the best treatment for you. While many people know about hip and knee replacements, many people don’t realise that a shoulder replacement is even possible. Yet shoulder replacements can be an extremely effective way of restoring mobility and reducing pain in the shoulder.
During this surgery, the natural ‘ball and socket’ joint of your shoulder is replaced with an artificial joint. A cut (incision) is made at the front of your shoulder, then the head of the humerus and the glenoid (‘socket’) of your scapula are both replaced with artificial components. This new artificial shoulder joint removes the problems caused by the worn cartilage of osteoarthritis and is designed to provide friction-free movement, improving the mobility of the joint while reducing the pain and stiffness you’ve been suffering from due to arthritis.
Once the joint has been replaced, the surgeon will carefully close any cuts made with stitches and place a sterile dressing over the wound to promote healing and reduce the risk of infection.
- Reverse total shoulder replacement surgery: In a standard total shoulder replacement, an artificial ball and socket joint is created using metal and plastic components. A healthy rotator cuff (the group of muscles and tendons surrounding your shoulder joint) is needed, as the new ball and socket joint will need these muscles and tendons to help keep it in place. If these tendons are damaged or torn, as can happen with rotator cuff tear arthropathy, an alternative approach is used which relies on other muscles to support the new joint, such as the deltoids (back muscles).
In reverse shoulder replacement, an artificial ball and socket joint is once again created with metal and plastic, but in this case the metal ball is placed on the socket side of your shoulder, and the plastic socket is attached to the top of your humerus, ‘reversing’ the joint. By bypassing the use of the damaged tendons and muscles in your rotator cuff, this procedure allows other muscles around your shoulder to support the joint, restoring your range of motion and helping to eliminate your pain.
Your surgeon may suggest a reverse shoulder replacement for a number of reasons, including:
- A torn rotator cuff, or one that is not working,
- Having previously had a shoulder replacement that has since failed,
- Having severely fractured your shoulder,
- Previous chronic shoulder dislocation,
- A tumour on the shoulder joint.