Osteoarthritis of the Shoulder
As a nurse in her 30s, I suffer from occasional aches and pains. I admit I am a bit overweight, but I stay active. I mountain bike, I do yoga, I walk, I downhill ski, I hike; I try to live an active lifestyle. However, several years of floor nursing and a variety of incident reports and emergency room visits have taken their toll on my body.
Enter shoulder pain. I have had shoulder pain off-and-on for several years. A few weeks ago, it intensified after a particularly tough HIIT workout. I began to wonder, “Could I have arthritis?” But I am too young to have osteoarthritis of the shoulder, right? Maybe not.
Who Can Get Osteoarthritis?
Osteoarthritis is the most common form of arthritis; 54.4 million adults have been told they have some form of arthritis, which accounts for approximately 22.7% of the population.
While osteoarthritis is most common in people aged 65 and older (49.6% of those diagnosed), those who are 18 to 44 account for 7.1%, which means that there is a possibility that I could have osteoarthritis, especially given my occupation and active lifestyle.
What is Osteoarthritis?
Osteoarthritis is the most common form of arthritis because it is generally caused by “wear and tear” of the joints, causing pain, swelling, and reduced range of motion. It is most common in the knees, hips, spine, and hands.
Osteoarthritis occurs when the cartilage, or the slippery tissue that covers the joints begins to wear down. Cartilage acts as a “shock absorber”, but when it wears down, the bones begin to rub together. Eventually, this constant rubbing will cause permanent damage to the joint.
Symptoms of Osteoarthritis
The most common symptoms of osteoarthritis include:
As osteoarthritis progresses, the pain intensifies. In addition, the joint can become swollen, spreading into the areas that surround the joint.
When osteoarthritis occurs in the shoulder, pain is typically the most common symptom. Pain is most likely to occur with movement and after movement. Pain that wakes you from sleep is also a characteristic of osteoarthritis of the shoulder.
Limited range of motion is typically evident, as is clicking and creaking noises.
How is Osteoarthritis of the Shoulder Diagnosed?
A physical examination is performed first. Your healthcare provider is looking for objective signs, such as muscle atrophy and weakness, as well as reviewing subjective symptoms, such as assessing pain and tenderness.
Common tests that are ordered to help diagnose osteoarthritis of the shoulder include:
- Blood tests, as blood tests can help to differentiate osteoarthritis from other types of arthritis, such as rheumatoid arthritis
- Diagnostic imaging such as x-rays and MRIs to take images of the shoulder
- Removal of the synovial fluid, which is the lining of the joint; this helps to analyze the fluid
Causes of Osteoarthritis of the Shoulder
Often, osteoarthritis is caused by “wear and tear”. The cartilage simply wears down over time. As such, age is one of the biggest risk factors.
Other potential causes of shoulder arthritis include:
- Joint malformation
- Poor posture
- Ligament injuries
- Torn cartilage
- Dislocated joints
Treatment of Osteoarthritis of the Shoulder
Treatment of shoulder osteoarthritis is aimed at improving the symptoms of osteoarthritis and improving range of motion.
Though rest doesn’t necessarily strengthen the joint, it does go a long way. This does not mean that you should lie in bed until the pain goes away (newsflash – it probably will not go away) but it does mean that you can find new ways to perform tasks so that the joint gets a break.
For example, if the action of putting on a hoodie hurts, wearing sweatshirts that zip up can allow the shoulder to rest. If you bake a lot and use a hand mixer, perhaps invest in a stand mixer.
There are a variety of medications that are useful to treat osteoarthritis pain that you can use. Though you should check with your healthcare provider, ibuprofen and aspirin, which are NSAIDs, can reduce pain and inflammation.
Short-term corticosteroids can be prescribed to reduce swelling and can even be injected into the joint. The supplements glucosamine and chondroitin are thought to improve joint pain. Research is conflicting but many people find relief.
Physical therapy for shoulder osteoarthritis not only can improve pain and improve mobility, but it can also restore the use of the joint, improve strength of the joint, improve the ability to perform activities of daily living, and maintain fitness.
Physical therapy is performed with a physical therapist at a prescribed interval; eventually, you will be able to perform the exercises at home.
When other treatment options fail, and pain becomes unbearable, surgical interventions are recommended. These are used as a last option because often we can manage with non-surgical options. However, there does come a point when quality of life is improved by surgery.
Surgery options include:
- Total shoulder arthroplasty, as this replaces the entire shoulder joint with an artificial joint
- Replacement of the head of the humerus
- Removal of a small piece of the end of the collarbone (resection arthroplasty), as it is useful to treat AC joint and rotator cuff problems