Signs and Symptoms
Shoulder arthritis symptoms usually come on gradually and may include:
- A deep ache in the shoulder, often felt at the back of the joint
- Stiffness and loss of motion, such as trouble reaching overhead or behind your back
- Difficulty dressing, combing your hair, or lifting objects to a shelf
- Grinding, clicking or catching when you move your arm
- Pain at night, especially when lying on the affected side
- Weakness lifting the arm, which can be a sign that the rotator cuff is also damaged
Neck problems and rotator cuff tears can cause similar shoulder pain, so a careful exam is important to find the true source.
What Causes It?
The main shoulder joint, called the glenohumeral joint, is a ball-and-socket joint. The ball is the upper end of the arm bone (humeral head) and the shallow socket is part of the shoulder blade (glenoid). Smooth cartilage covers both surfaces. In osteoarthritis, this cartilage thins and roughens over time, so bone rubs on bone and bone spurs form around the joint.
- Age and genetics, the usual background for osteoarthritis
- Rheumatoid arthritis, an inflammatory disease in which the immune system attacks the joint lining
- Arthritis after an old injury, such as a fracture near the shoulder or a past dislocation (when the ball came out of the socket)
- Rotator cuff tear arthropathy, arthritis that develops after a large, long-standing rotator cuff tear lets the ball ride up and wear against the bone above it
How We Diagnose It at POPB
Your physician will ask about your pain, activity and goals, then check how your shoulder moves, how strong your rotator cuff is and whether the pain might be coming from your neck. X-rays of the shoulder are taken on site, usually at the same visit, and are often enough to diagnose arthritis.
MRI and diagnostic ultrasound are available in our office when more detail is needed, most often to check the rotator cuff, because its condition guides treatment. Shoulder arthritis is treated by Dr. Wolfson and Dr. Tucker, with Dr. Adelman providing non-operative care and ultrasound-guided injections.
Non-Surgical Treatment Options
Non-surgical care aims to reduce pain and keep your shoulder moving:
- Activity changes, such as avoiding heavy overhead lifting and adjusting how you reach and carry
- Physical therapy in our office for gentle motion and strength, with your therapist working from the same chart as your physician
- Anti-inflammatory medication or acetaminophen, if safe for you
- Cortisone injections into the shoulder joint to calm inflammation, with ultrasound guidance available to place the medicine accurately
If you have Medicare and osteoarthritis, you may qualify for our Care Management program, with monthly check-in calls and no extra office visits.
Surgical Options
When pain limits your sleep or daily activities despite non-surgical care, shoulder replacement is usually the recommended surgery. The choice of design depends mainly on your rotator cuff, the group of four muscles and tendons that hold the ball in the socket.
- Total (anatomic) shoulder replacement: the worn ball and socket are replaced with implants in their natural positions. This design needs a rotator cuff that is still working.
- Reverse shoulder replacement: the ball and socket switch places, which lets the deltoid muscle lift the arm. It is used when the rotator cuff is badly torn and for rotator cuff tear arthropathy.
Both operations are performed by Dr. Wolfson, a board-certified orthopedic surgeon fellowship-trained in sports medicine and arthroscopy who performs both reverse and anatomic shoulder replacement, and Dr. Tucker, a fellowship-trained, board-certified hand and upper extremity surgeon who performs total and reverse shoulder replacement. Your surgeon will explain which design fits your shoulder.
Recovery
With non-surgical care, many people notice less pain and better motion over several weeks of regular therapy and exercise, though arthritis tends to progress over time.
After shoulder replacement, most patients wear a sling for several weeks, often around four to six. Therapy is staged, starting with gentle motion and adding strength later, and many people return to everyday tasks within a few months. Physical and occupational therapy can be done in our office. Timelines vary.
Insurance and Cost
Medicare and most commercial PPO plans generally cover office visits, X-rays, physical therapy, cortisone injections and medically necessary shoulder replacement, subject to your co-pay, co-insurance and deductible. Shoulder replacement often requires prior authorization from your plan.
HMO and managed-care plans require a referral from your primary care physician before your visit. Our staff verify your benefits when you call.
When to Be Seen
Call our office if shoulder pain or stiffness lasts more than a few weeks, limits reaching or dressing, or wakes you at night. If a sudden injury leaves your shoulder looking deformed or out of place, go to the emergency room or call 911. After shoulder surgery, go to the emergency room or call 911 if you have fever, spreading redness or drainage from the incision. For other questions after hours, call our main office number to reach the answering service.
