The shoulder is made up of four separate joints:
- The glenohumeral joint is the ball and socket joint that connects the humerus bone (upper arm bone) to the scapula (shoulder blade).
- The acromioclavicular joint is the joint between the end of the clavicle (collarbone) and the scapula.
- The sternoclavicular joint is the joint between the sternum (breastbone) and the clavicle.
- The scapulothoracic joint is the joint between the scapula and the ribcage.
In every joint in the body the ends of the articulating surfaces are covered in hyaline cartilage. Cartilage is a tough, flexible tissue found throughout the body. It covers the surface of joints, acting as a shock absorber and allowing bones to slide over one another.
Over time this cartilage can gradually roughen, become thin and break down or degenerate.
Joint degeneration, also known as osteoarthritis, can affect any joint in the body, including the shoulder. Shoulder joint degeneration is most common in the glenohumeral and acromioclavicular joints. Joint degeneration tends to involve two primary processes; firstly the breakdown of the cartilage, followed by the development of osteophytes.
Osteophytes are bony growths or bone spurs that can develop in joints as the body is attempting to heal itself. These processes result in a number of potential symptoms:
- Limited range of movement
- A feeling of catching and grinding
Whilst it is not always known exactly how and why osteoarthritis develops within the shoulder there are a number of traits that can potentially be linked with the condition including:
- Previous history of trauma (fracture, dislocation) which can cause permanent damage to the shoulder joint
- Shoulder joint stress/overuse such as occupational or recreational activities which put lots of stress on the shoulder joint, especially those which require spending a lot of time with the arm in an overhead position
- Age: shoulder arthritis is most common in people over the age of 50
Diagnosing degenerative conditions of the shoulder can be achieved a number of ways. It may be possible to diagnose through a full history taking and physical examination by a doctor or physiotherapist.
It might also be necessary to have imaging, such as an X-ray or a CT scan, in order to confirm the diagnosis of degenerative conditions of the shoulder and to differentiate other common shoulder joint conditions such as frozen shoulder (adhesive capsulitis).
There are a number of different treatments available to help treat degenerative conditions of the shoulder. Usually the options include a stepped up approach to care, meaning that the least invasive treatment options are considered first and the more invasive treatment are considered when the less risky non-invasive treatments have failed.
Non-invasive treatments for degenerative conditions of the shoulder include:
- Activity modification: avoiding or adapting certain activities that cause pain might be necessary either short term during acute flare-ups of pain or long term.
- Pain relief: Painkillers such as paracetamol or non-steroidal anti-inflammatories such as ibuprofen can be effective in relieving the pain and inflammation associated with degenerative conditions of the shoulder; however the effects tend to be short term.
- Hot/cold therapy: heat therapy such as a hot water bottle or heat pack can be effective in loosening up a stiff joint and encouraging more movement. Whereas ice therapy using an ice pack for 10-15 minutes after activity can help to reduce and manage any inflammation.
- Exercises: specific shoulder exercises can be very effective in managing symptoms that arise from degenerative conditions of the shoulder. Circles highly-skilled physiotherapists can construct an exercise programme with specific individualised exercises that are appropriate for people with degenerative conditions of the shoulder. Shoulder mobility exercises and stretching can be very effective in helping to improve or maintain shoulder range of movement. Strengthening and resistance exercises can be very effective in helping to strengthen the muscles around the shoulder in order to try and provide as much stability as possible in the shoulder joint. It is also important to be aware that these exercises are likely to be somewhat painful, and that does not mean that further damage or injury is being done and the exercises should be continued. These exercises should be performed regularly and consistently over a long period of time, with the physiological benefits only becoming evident after at least three months.
If these non-invasive treatments fail then invasive treatments can be considered, including:
- Corticosteroid injections: Corticosteroid injections can be helpful in providing short term pain relief in people with degenerative conditions of the shoulder if non-invasive treatments have not been successful. Corticosteroids are anti-inflammatories and therefore these injections can be helpful in people with significant inflammation or degeneration in their shoulder joint. If you are having an injection it will normally take a few days to work if it is going to be effective. If effective then the effects of the injection can usually last for up to three months. It is also important to be aware that there are risks associated with corticosteroid injections, although these are extremely minimal and less than 1% in percentage terms. The main risks associated with injection therapy are: increased pain which may last up to 12-24 hours post injection; infection which is extremely rare and normally documented as less than 1 in 10,000 to 100,000; allergic reaction to the medication used known as an anaphylactic reaction. This too is extremely rare and the incidence is less than 1:100,000
- Arthroscopic shoulder release surgery: a shoulder arthroscopic release is a procedure performed on patients who have been experiencing shoulder joint stiffness with the aim to release the tightness found in the capsule. A small camera is placed through the back of the shoulder through a tiny incision so the surgeon can get a good look around inside the shoulder. Then a little instrument is introduced through the front of the shoulder under direct view to cauterize the scar tissue and clean out the joint. At the end of the surgery the shoulder is moved around to make sure that full range of movement has been gained. If it has not, then a manipulation will be completed where the surgeon will apply extra force to the joint to gain the extra movement.
- Shoulder replacement surgery: if the osteoarthritis is very severe then a shoulder replacement surgery can be considered. Shoulder replacement surgery is the shoulder equivalent of hip or knee replacement surgery and involves replacing the entire shoulder ball and socket joint (glenohumeral joint).
Osteoarthritis of the shoulder is a progressive degenerative condition that cannot be reversed. That does not necessarily mean that the pain will be constant and worsening. Therefore, there is no real timeframe in terms of recovery from degenerative conditions of the shoulder.
This means that it is all about management of these conditions, especially during acute flare-ups when the pain, stiffness and restriction in function is likely to be at its most severe.