Shoulder osteoarthritis is a degenerative joint disease which occurs when the cartilage that covers the tops of the bones degenerates or wears down. Dr. Mario Borroni, the Orthopedic Unit shoulder surgeon in Humanitas, explains that there are currently two known forms of shoulder athritis.
What is osteoarthritis of the shoulder and what are the symptoms?
Shoulder osteoarthritis is generally a progressive condition. There is a primary form, the cause of which is not yet known, and a secondary form, which can be linked to trauma. It ranges from an inflammatory diseases that affects where the two bones in a joint meet (such as rheumatoid arthritis), metabolic diseases (for example diabetes, gout), to anatomical malformations that alter the functioning of the joint and cause pain particularly during arduous activities for the shoulder.
“In the latter case, osteoarthritis in the shoulder can be dysfunctional: This joint has a very delicate balance, guaranteed by the combined action of muscles and capsular ligamentous structures. As long as all the elements are in balance the shoulder works well and has good biomechanics. The moment an alteration occurs, even if only on one of these elements, the shoulder loses its equilibrium and may become stiff or unstable. When this happens, the chances of wear of the cartilage increases, and the subsequent onset of osteoarthritis occurs” said Dr. Borroni.
Shoulder osteoarthritis typically begins with localized joint pain, sometimes radiating to the neck area or down the arm. At first pain is mainly due to movement. With progression of the disease, there is pain even when the shoulder is at rest. There is particular intensification of this pain at night when the shoulder rests. A more severe stage is joint limitation that leads to the loss of functionality.
What is the cure to shoulder osteoarthritis?
Shoulder arthritis involves the cartilage, a structure that can not be regenerated. Therefore there is no real cure. Instead there are very effective palliative treatments.
Anti-inflammatory or analgesic drug therapies “may give a better quality of life to the patient; this benefit is usually temporary because of the evolutionary trend of the disease” explains Dr. Borroni.
Rehabilitation is based on the recovery of a range of motion and muscle rebalancing. “Conservative palliative treatments may include physical therapy, such as TENS and Tecartherapy, which can give some benefit to patients regarding pain”.
We also use infiltrative therapies which are based on using cortisone and hyaluronic acid. The first is an effective anti-inflammatory drug. Hyaluronic acid “is one of the components of connective tissue and has the purpose of lubricating the joint, cushioning the mechanical stress and preserving the cartilage. Thus improving the functionality of the shoulder and reducing pain” comments Dr. Borroni.
When do we consider surgical intervention?
If conservative treatments do not provide a benefit, or if the functional impairment is severe, you may need surgery. We can also perform surgery if you feel intense pain that is not alleviated by conservative treatments. Dr. Borroni explains that “Surgical treatment of shoulder osteoarthritis is essentially a prosthetic replacement similar to the hip or knee. There are several implants, whether partial or total, which are well suited to the different pathological situations and characteristics of each patient. The results are effective against pain and restoring functionality. Latest studies indicate that shoulder prosthesis have a good life time of 15-20 years.
Today this intervention is suggested for patients who are at least 65 years old. We also see prosthetic surgery in younger people with severe arthritis usually as a result of trauma”.