Shoulder Arthritis Shoulder Arthritis in the Active Person

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1 Shoulder Arthritis Shoulder Arthritis in the Active Person Nick Aberle, MD Boulder Orthopedics Arthritis is a loss of the normal, smooth gliding cartilage in the shoulder 50 million Americans sought care for arthritis in 2013; this number is increasing Affects approximately 20% of people 60 or older It is often a slowly progressive disease There are many causes of arthritis The Shoulder, 4 th edit, 2009 Normal Shoulder Normal Shoulder

2 Normal Shoulder Causes of Shoulder Arthritis Osteoarthritis Most common; wear and tear Rheumatoid arthritis Often associated with arthritis in other joints as well Post Traumatic A single event can cause injury to cartilage, which worsens over time Large Rotator Cuff Tear When it has been present for a long time Shoulder Arthritis Shoulder Arthritis

3 Symptoms of Shoulder Arthritis Pain Most common complaint people have regarding their shoulder with arthritis Often, it is pain the back or front of shoulder and it is worse the more someone uses the joint Worse sleeping on the affected side Decreased motion May be present with a rotator cuff tear as well Painful catching/popping with motion Symptoms of Shoulder Arthritis Weakness may mean that a rotator cuff tear is present as well Physical Exam is important, as are xrays There are many causes of shoulder pain! Occasionally, an MRI is helpful to determine the cause(s) of shoulder pain Overall, it is best to start conservatively Treatment varies based on the patient s goals and the underlying problem The Shoulder, 4 th edit, 2009

4 Physical Therapy Over time, the joint lining can become tight and muscles weaker PT can help address this Medications Anti inflammatory medications can be useful in arthritis May need to try more than one type Buchbinder. Cochrane Database Injections Two main types, cortisone and viscosupplementation Both can be effective Cortisone is used more often, as insurance doesn t pay for the other type Partington. Journal Shoulder and Elbow Surgery Sethi. Journal of Arthroscopy Buchbinder. Cochrane Database Hanchard. Journal of Rheumatology Cortisone Helps to alleviate pain Reduces inflammation Often given with a local anesthetic (numbing medicine) mixed in Cortisone can take 2 3 days to take effect Very small risk of infection; may temporarily elevate blood sugars in diabetics Viscosupplementation has worked well in clinical studies, however, insurance doesn t pay for it Out of pocket May be useful to avoid/delay surgeries such as joint replacement May last longer than cortisone Kwon. Journal of Shoulder and Elbow Surgery

5 Shoulder Arthroscopy Can be useful early on in the disease process Most useful when there is painful catching or popping During the procedure, the entire joint is inspected and any abnormalities are dealt with appropriately Exactly what is done may vary from patient to patient Shoulder Arthroscopy Treat any rotator cuff tears Remove any loose pieces and trim any loose flaps of cartilage that may be causing pain Microfracture may be appropriate Release any tight areas of the joint lining that may be limiting motion Richards & Burkhart. Arthroscopy Millet. Arthroscopy Richards & Burkhart. Arthroscopy Millet. Arthroscopy Microfracture Microfracture The damaged area of cartilage is cleared away and small holes (millimeter) are punched into the bone This allows the bone marrow to leak out and fill the missing cartilage A cross between scar tissue and cartilage forms, which helps reduce pain Richards & Burkhart. Arthroscopy Millet. Arthroscopy Gross. Arthroscopy. 2012

6 Recovery after Shoulder Arthroscopy This can vary greatly, depending on exactly what was done during the surgery Usually, 2 weeks in a sling and physical therapy is started soon to help prevent shoulder stiffness If anything repaired, or if microfracture is performed, then recovery takes a lot longer 6 weeks in a sling and more intense PT Sports after months At times, the previous treatment don t work well enough, or the arthritis gets worse Then, we will start talking about shoulder replacement There are 3 main types of shoulder replacement, depending on the underlying problem and the patient s goals Hemiarthroplasty (partial) The ball side of the shoulder joint is replaced Total shoulder arthroplasty The ball and socket are replaced Reverse shoulder arthroplasty Appropriate for large, long standing rotator cuff tears Hemiarthroplasty

7 Total shoulder arthroplasty The ball and socket are replaced Reverse shoulder arthroplasty Appropriate for large, long standing rotator cuff tears Picture of shoulder replacements are from Tonier, Inc. For most people, the decision is between the partial and total shoulder replacement There are pros and cons of each that need to be considered on a patient by patient basis

8 Hemiarthroplasty (partial) The ball is replaced and sometimes the socket may need to be smoothed Good pain relief Allows patients to participate in any activity that they want Swimming, climibing, golf, racket sports, etc. Gartsman. Journal of Bone and Joint Surgery Total Shoulder replacement Both ball and socket replaced The socket is the weak link in how long this lasts The socket can loosen and this happens more often in active people This can lead to the need to redo part of the surgery However, there is better pain relief than partial replacement Gartsman. Journal of Bone and Joint Surgery Recovery Shoulder Replacement 1 2 days in the hospital Sling for 6 weeks, during which time you will start physical therapy PT focuses initially of your range of motion and then strengthening starts around 12 weeks after surgery Full recovery varies, 6 9 months Risks of Shoulder Replacement There are risks with any type of operation Infection Can be very difficult to treat when a new joint is in place Damage to nerves/blood vessels rare Continued pain Stiffness Need for a revision (redo part/all of the surgery years down the road)

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