Treatment of arthritis of the shoulder may consist of simple home remedies, physical therapy or in more severe cases, surgical intervention. To some degree, treatment of arthritis of the shoulder depends on the causes of the disorder. Shoulder arthritis may be of two types, osteoarthritis or rheumatoid arthritis, each due to several causes.
Treatment of Shoulder Arthritis
A prescribed course of physical or occupational therapy may do wonders for a patient suffering from arthritis. In addition to teaching the patient exercises to increase mobility and flexibility, such treatment enables the patient to become more aware of how arthritis affects the movements of the body and vice versa. Understanding the nature of the condition helps the patient to avoid putting stress on the shoulder joints. In addition, such therapies help patients to respect their own pain levels and to avoid exacerbating damage and discomfort.
When nonsurgical treatments do not produce effective results and the patient is unable to continue with normal activities due to severe pain, surgical intervention may be necessary. Surgical procedures may include:
Total shoulder arthroplasty- Performed to treat arthritis of the glenohumeral joint, this procedure, also called shoulder joint replacement, involves replacing the whole shoulder.
Hemiarthroplasty- This surgical procedure, also used to treat arthritis of the glenohumeral joint, involves a replacement of the head of the humerus.
Resection arthroplasty- During this surgery only a small piece of the end of the collarbone is removed. This is the most common surgery used to treat arthritis of the acromioclavicular, or AC joint.
Rotator Cuff Tear
The rotator cuff is a group of tendons and muscles that support the shoulder joint and allow for complete movement while keeping the ball of the arm bone in the shoulder socket. These tendons and muscles may become torn or otherwise damaged from injury or overuse and can lead to pain, weakness and inflammation. Surgery may be used to treat this often serious condition.
Arthroscopic Rotator Cuff Repair
Rotator cuff surgery may be performed arthroscopically or through an open procedure, depending on the type and severity of the condition. Both procedures are usually performed under general anesthesia, although with the arthroscopic method a regional anesthesia can be used instead to numb the shoulder and arm . The purpose of the procedure is to reattach the tendon back to the arm, along with removing any loose fragments from the shoulder area.
Most rotator cuff procedures can now be performed through arthroscopy, which uses a few tiny incisions rather than one large incision. This technique offers patients minimal trauma, less scarring and less damage to the surrounding muscles and tissue. The smaller incisions also result in less pain in the shoulder joint after the surgery.
During arthroscopic rotator cuff repair, several small incisions are made in the shoulder, into which a thin tube and tiny instruments are inserted. The surgeon repairs the tendon through visualization on a television monitor. This technique also allows for shorter recovery times than the traditional, open surgical method, which is now generally reserved for only very large or complex tears.
Reverse Total Shoulder Replacement
Reverse total shoulder replacement is a surgical intervention that aims to repair a condition known as rotator cuff tear arthropathy. This is different than total shoulder replacement because it switches the formation of the glenoid-humeral joint. Naturally, the "ball" of the joint exists as the terminal end of the humerus, but after this procedure the glenoid will be changed into a spherical object that the humerus head can articulate around. This allows the deltoid muscle to lift the arm instead of the torn rotator cuff.
Although this is a very effective method for relieving pain at the shoulder joint, it is normally the last option considered. It is still an invasive surgery that resurfaces the bones, which can be very risky, especially in patients most likely to require this surgery. The bones of elderly individuals are continually weakening as they age, so it is important for doctors to take this into account when determining if the surgery is worthwhile. Additionally, the patient may no longer be able to lift their arm more than a 90 degree angle after this procedure.
A labrum is a protective cuff of cartilage found in ball and socket joints like the hip and shoulder. It provides more stability, cushioning and a full range of motion for these shallow joints. A tear in the labrum, known as a labral tear, is caused by injury or overuse and can lead to pain and "catching" of the joint while moving.
While many labral tears can be treated by managing pain symptoms and undergoing physical therapy, some cases require surgical treatment. Labral repair surgery aims to repair unstable shoulders with staples, anchors or sutures. The procedure is usually performed through arthroscopy, which allows the doctor to view the tear through a small camera and perform the procedure through tiny incisions. Larger tears may require an open procedure.
Labral repair surgery is usually effective in treating labral tears and restoring full movement and strength. Recovery time depends on the type of procedure but usually takes several months.
Shoulder instability is a condition characterized by a loose shoulder joint that is able to move too much within the socket. Sometimes it becomes a chronic problem after a dislocation, which occurs when the ball of the upper arm bone comes out of the socket. The resulting instability may produce frequent slipping, or partial dislocation known as subluxation, as well as full dislocation.
Shoulder instability can occur after an acute injury that stretches or tears the ligaments in the shoulder or be due to overuse. In other cases, a naturally loose joint capsule simply does not hold the ball of the humerus tightly in its socket. Athletes whose sports involve repetitive overhead motions, such as tennis and volleyball players and swimmers, have a higher instance of developing instability. The shoulder is more susceptible to this type of condition than other joints are because it provides the arm with a tremendous range of motion. If a dislocation takes place, the muscles, tendons and ligaments of the shoulder may tear or loosen, resulting in the persistent slippage associated with instability.
People with unstable shoulders may experience pain and limited motion in the joint and feel that moving in the wrong way will cause their shoulder to dislocate. This may discourage participation in sports that require stretching the arm overhead. Younger patients who experience a traumatic dislocation are more likely to develop shoulder instability.
Treatment of Shoulder Instability
Treatment for shoulder instability usually begins with conservative measures including resting the affected arm, physical therapy and use of non-steroidal anti-inflammatory medications; however, for some people these approaches may fail to provide relief. At that point, surgical treatment may be recommended. Instability surgery varies depending on the cause of the condition, but usually aims to tighten the loose ligaments of the shoulder. The two most common types of instability surgery include Bankart repair and capsular shift procedures, which may be performed in combination.
Surgery to repair a Bankart lesion can often be performed through arthroscopy. Arthroscopy is a minimally-invasive technique that uses tiny incisions to insert a probe-like camera, allowing your surgeon to fully examine the area before performing corrections. The surgeon will then insert specialized instruments through the arthroscope to repair the damage to the shoulder at the exact location of the injury. These small incisions allow for more precise movement and reduce the risk of infection and other complications of surgery. Arthroscopy is especially effective in treating joint conditions such as when Bankart repair is necessary. This technique offers patients minimal pain and trauma, less scarring and less damage to surrounding tissue as well as a faster recovery and shorter length of rehabilitation than with traditional open surgery.
Capsular Shift- is used to decrease and tighten the joint capsule, which is the lining of the joint, when it is too large. This is accomplished by folding the affected ligaments over on themselves and suturing them in this more layered position.
Both of these outpatient surgeries can often be performed through arthroscopy, which allows for minimally invasive procedures with smaller incisions and shorter recovery times.