Shoulder Arthritis
Background
The shoulder is a ball and socket joint. Smooth cartilage covers the ball at the top of the upper arm bone and the socket of the shoulder blade, allowing them to move against each other. Shoulder arthritis develops when that cartilage wears down, causing pain, stiffness, and difficulty using the arm.
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Arthritis may develop gradually with age or follow an injury, prior surgery, or a long standing rotator cuff tear. When a large rotator cuff tear occurs along with arthritis, it is often called cuff tear arthropathy. The condition of the rotator cuff is important because it helps determine which type of shoulder replacement may work best.
Symptoms
Patients with shoulder arthritis may experience:
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Deep shoulder pain that gradually worsens
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Stiffness or loss of motion
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Pain with reaching, lifting, or dressing
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Pain at night that interrupts sleep
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Grinding or catching with movement
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Weakness or difficulty raising the arm
Diagnosis
Diagnosis begins with a discussion of symptoms and an examination of shoulder motion and strength. X-rays show the amount of joint space remaining, bone spurs, and changes in the shape or position of the joint.
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If surgery is being considered, a CT scan may help assess the shape and bone quality of the socket. An MRI or ultrasound may be used when the condition of the rotator cuff needs further evaluation. These findings help guide the choice of treatment and shoulder replacement.
Treament Options
Treatment depends on the severity of arthritis, the condition of the rotator cuff, and how much symptoms interfere with daily life.
Nonoperative Treatment
Initial treatment may include changes to painful activities, physical therapy to maintain motion and strengthen the muscles around the shoulder, and medication when appropriate. A corticosteroid injection may provide temporary pain relief. These measures can improve symptoms, although they cannot restore cartilage that has worn away.
Anatomic Total Shoulder Replacement
An anatomic total shoulder replacement replaces the worn ball with a metal ball and the socket surface with a smooth implant. It preserves the shoulder’s normal ball and socket arrangement and relies on a functioning rotator cuff to move and stabilize the joint.
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An anatomic replacement is commonly considered when the rotator cuff is healthy or can function well and the socket can support the implant. It can provide substantial pain relief and improved motion for appropriately selected patients.
Reverse Total Shoulder Replacement
A reverse total shoulder replacement switches the arrangement of the joint: a metal ball is placed on the shoulder blade, and a cup is placed on the upper arm bone. This design allows the deltoid muscle to do more of the work of raising the arm.
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Reverse replacement is often recommended when arthritis is accompanied by a large, irreparable rotator cuff tear. It may also be considered when there is significant socket bone loss, rotator cuff dysfunction, or other factors that make an anatomic replacement less reliable.
Return to Sport
Most patients return to many everyday activities by three months after shoulder replacement. Sports are added gradually. Golf chipping and light tennis ground strokes may begin around four months, followed by practice golf swings without hitting a ball around five to five and a half months. Many patients can return to full golf and tennis around six months, depending on their motion, strength, and comfort. Continuing daily stretching helps maintain shoulder function, and improvements in strength and motion can continue for more than a year.