Shoulder

What you Need to Know about Osteoarthritis of the Shoulder?

By October 1, 2019 October 25th, 2019 No Comments

Osteoarthritis of the Shoulder

Osteoarthritis of the shoulder is a degenerative illness that may gradually induce pain and swelling and reduce the range of motion of an individual.

By understanding the anatomy of osteoarthritis of the shoulder, its probable symptoms, and underlying causes, an individual may be able to make a more educated decision for their treatment.

Anatomy of Osteoarthritis of the Shoulder

Osteoarthritis of the Shoulder is a condition that involves degenerative changes to the cartilage and other structures within the shoulder. Specifically, when people say shoulder osteoarthritis what they are really referring to is damage to the soft tissues found in the glenohumeral joint – where the ball of the upper arm bone meets a bone known as the “glenoid”.

The upper arm bone and the glenoid form into a ball and socket joint wherein the glenoid provides a “pocket” for the rounded end of the upper arm bone (humerus). This pocket provides enough surface area to allow for the wide range of motion we are accustomed to in our arms.

In a healthy shoulder, both the glenoid and the ball of the humerus are coated in a layer of slippery cartilage which allows for smooth movements between the two bones. The cartilage also provides a protective layer that keeps the bones from touching one another as they move.

As the cartilage wears away due to everyday movement or one-off traumas, the bones may begin to grind against one another causing pain, swelling, stiffness, and eventually osteoarthritis of the shoulder.

Signs and Symptoms of Osteoarthritis of the Shoulder

Osteoarthritis of the shoulder has similar signs and symptoms to other degenerative illnesses. Some of these signs include:

  • Pain, especially during arm movement
  • Swelling of the shoulder
  • Stiffness and reduced range of motion
  • Numbness up and down the arm
  • Cracking or popping of the shoulder during movement

Nearly all movements of the arm involve the shoulder, and due to this, even a mild case of shoulder osteoarthritis can lead to severe pain. If these signs recur frequently, it may be time to seek a professional medical opinion.

Causes of Osteoarthritis of the Shoulder

The causes of an individual’s shoulder osteoarthritis lead to one of two different diagnoses – primary or secondary.

Primary osteoarthritis of the shoulder is those cases that have no specific cause. These cases are typically attributed to an individual’s age, genetics, and sex. Women over the age of 50 are the most likely to be diagnosed with primary osteoarthritis of the shoulder, but diagnosis in older men is not uncommon.

Secondary osteoarthritis of the shoulder is those cases that have an underlying factor. Typically, secondary osteoarthritis is attributed to:

  • Previous shoulder injuries
  • Frequent shoulder dislocations
  • Infection
  • Rotator cuff tears

Individuals with occupations or recreational hobbies that involve frequent use of the shoulder are most likely to be diagnosed with shoulder osteoarthritis.

Diagnosing Osteoarthritis of the Shoulder

Typically, the diagnosis of osteoarthritis of the shoulder begins with a physical examination and review of the patient’s medical history. The physical examination will most likely involve palpation tests (where the doctor applies pressure to various portions of the shoulder and upper arm) and a few ranges of motion exercises.

As the examination goes on, the patient will be asked to identify sources of pain, tenderness, and loss of motion. These tests give doctors an idea of the state of the humerus, glenoid, and surrounding tissues and may give them enough to determine if the joint shows signs of muscle atrophy, cartilage damage, or other indicating factors of osteoarthritis.

If the doctor identified signs of a deeper issue, they may do follow up examinations using one of the following methods:

  • X-rays
    • X-rays are used to examine the state of the bones. Doctors will watch out for wear, damage, and the development of bone spurs.
  • MRI scans
    • MRIs give doctors images of the soft tissues within the shoulder such as the tendons, muscles, and blood vessels.
  • Blood tests
    • Blood tests for osteoarthritis of the shoulder are typically used to rule out other illnesses as causal factors.
  • Synovial fluid examinations
    • Synovial fluid provides lubrication to the ball and socket of the shoulder. Extracting a small portion of the synovial fluid can help doctors identify infections, abnormal red blood cell counts, crystals which may be signs of gout, and the levels of protein, sugars, and other substances within the shoulder.

Typically, doctors will apply several of the above techniques in order to rule out other potential causes of a patient’s shoulder pain. If the results from these techniques indicate that a patient has osteoarthritis of the shoulder, a doctor will prescribe one, or several, conventional treatment options depending on the progression of the illness.

Conventional Treatments for Osteoarthritis of the Shoulder

There are several conventional treatments for osteoarthritis of the shoulder. Given the progression of the illness and the age of the patient, doctors will create a treatment plan aimed at meeting the functional needs of the individual while fitting their lifestyle. Physical therapy, medication, steroidal injections, and surgery are the most popular solutions to treat the pain caused by osteoarthritis of the shoulder.

Physical Therapy

It’s an umbrella term for treatments by physical means such as massage, heat treatment, or exercise. These methods are aimed at reducing pain, increasing range of motion, and strengthening the surrounding muscles of the shoulder.

Massage can help increase blood flow, heat treatments may be used to reduce swelling, and exercise not only helps strengthen the anterior muscles but may help increase the range of motion of the shoulder. Additionally, these practices need not be applied by professionals, many of these treatments can be administered at home without the need for expensive sessions with a trained therapist.

Individuals who desire a much more non-invasive and cost-friendly approach to their shoulder osteoarthritis favor physical therapy in dealing with their pain.

Medication

Most likely, doctors will begin a course of medication by recommending over-the-counter anti-inflammatory medication such as aspirin, ibuprofen, and naproxen. If these medications fail to relieve the pain caused by shoulder osteoarthritis over several weeks, doctors may prescribe stronger, more potent anti-inflammatory medication.

Steroidal Injections

First popularized in the 80s, steroidal injections have become an all-too-common treatment method for the pain from degenerative illnesses. Steroids help to reduce inflammation thereby reducing pain-inducing pressure to the nerves within the shoulder. Though these methods seem to provide a level of relief, prolonged use comes with a host of problems. Steroids have come under fire recently due to their degenerative effects. Over time, exposure to steroids may worsen the symptoms of shoulder osteoarthritis.

Surgical Intervention

Surgery is often the last resort for patients suffering from shoulder osteoarthritis. Extended recovery periods, reduced the range of motion, and low overall effectiveness makes surgery a non-desirable option for most patients. Moreover, post-surgical recovery may involve the use of some of the above-listed methods in addition to the surgery, which may dissuade patients from attempting surgical intervention in the first place.

If surgery is attempted, there are a variety of options available:

  • Shoulder arthroscopy
    • Removes loose pieces of damaged cartilage.
  • Shoulder osteotomy
    • Shaves off bone spurs and reduces friction between bones.
  • Shoulder arthroplasty / total joint replacement
    • Replaces the ball-and-socket glenohumeral joint with an artificial one.
  • Hemiarthroplasty / partial joint replacement
    • Replace just the humeral head of the upper arm with an artificial one.

There is a lot to consider when choosing a treatment option. Recovery time, statistical effectiveness, and potential for abuse (of medication) are all weighing factors when determining the best course of action for treating osteoarthritis of the shoulder. While conventional treatments are the most commonly prescribed, alternative methods are available and may provide better results.

Regenerative Therapy for Osteoarthritis of the Shoulder

While conventional treatments are the most commonly prescribed for the pain caused by osteoarthritis of the shoulder, they may not be the most effective. Regenerative therapy not only helps to alleviate shoulder osteoarthritis pain but also treats the underlying causes of it.

By extracting certain tissues from a patient’s body, processing them, and reinjecting them into the site of an injury, regenerative therapies help draw the body’s natural defenses to the problem area. These regenerative therapy techniques are known as Platelet Rich Plasma (PRP) or Stem Cell Therapy.

PRP Therapy

PRP works by isolating the platelets in a patient’s blood, mixing them with growth factors, and then injecting this solution into the degenerated area. Platelets are the body’s first defense against damage. Once an area is damaged, the body sends platelets to the site of injury where they clot together and signal the body to send growth factors to restore damaged tissue.

PRP works much the same way. Using special imaging technology and precise injection tools, doctors are able to locate the most damaged portion of the shoulder and apply PRP to the area to signal the body to send regenerative cells to repair the damage.

Stem Cell Therapy

Similar to PRP, stem cells are harvested directly from tissues within the patient’s body. Adipose (fat) tissue is typically used. Once the tissue is extracted, special cells within the tissue are isolated and processed to become pseudo-stem-cells known as mesenchymal stem cells.

Once these tissues are processed and reinjected into the site of injury, they first create a type of incubating shelter around the damaged tissues. Once the environment is established, the cells call on the body to provide the building blocks with which to reconstruct damaged portions of the soft tissues in the shoulder.

While conventional treatment options may offer some relief from the pain caused by shoulder osteoarthritis, they do little to actually rebuild the damaged tissue, and only prolong the symptoms. Regenerative therapies offer a solution to this issue by giving the body what it needs to help replenish tissue which has degraded. Moreover, these therapies can be used in conjunction with conventional methods in order to reduce recovery periods and amplify the results of any physical therapies used.

Conclusion

Shoulder osteoarthritis may be a very limiting disease. By depleting the stores of cartilage in the shoulder, osteoarthritis creates pain, induces swelling, and reduces an individual’s range of motion.

While conventional treatment options may be the most popularized by doctors, alternatives such as regenerative therapy may provide another avenue to help alleviate any of the symptoms experienced by an individual.

If you would like to learn more about how regenerative therapies work, what they do, or what a typical procedure may be like, contact the Cellaxys offices today to set up a consultation.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni