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Ask the BayCare Clinic Specialist: Don’t ignore shoulder pain

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Man holding shoulder as if in pain

Question: I’ve been experiencing increasing amounts of pain and stiffness in the front of my shoulder. Over my 62 years, I’ve separated my shoulder a few times and have injured it in the past too. The pain is worse after activities and usually gets better after some rest. Am I dealing with arthritis?

Answer: Based on the information you provided I believe you may be dealing with a form of arthritis – perhaps glenohumeral osteoarthritis.

This is a relatively uncommon form of the disease, though I am seeing an increased amount in clinic. Only a physical exam and specific diagnostic tests can determine the cause of your pain and stiffness. Glenohumeral osteoarthritis can be a condition which leads to pain and stiffness, so let’s explore the issue.

There are two joints in the shoulder – the acromioclavicular joint and the glenohumeral joint. Osteoarthritis is more often found in the AC joint, though it can occur in the glenohumeral joint.

The glenohumeral joint is more commonly referred to as the shoulder joint and is where the upper arm bone – humerus – meets the shoulder blade – scapula. The joint is a ball and socket joint – the end of the humerus forms a ball which rests in the scapula, which allows for a full range of arm movement. As with most joints, a layer of thick, durable cartilage lays between these two bones to allow for cushioning. A collective series of muscles and tendons form the rotator cuff, which allows for movement while offering stability.

When a shoulder dislocates, it becomes weakened through stretched ligaments and tendons. It is not uncommon to also damage the cartilage within the joint. As you age and the shoulder cartilage wears, these issues can be compounded. When worn away, bone on bone movement will lead to increasing pain, discomfort and stiffness.

Late-stage glenohumeral osteoarthritis is less likely to respond to conservative treatments which include over-the-counter pain relievers, physical therapy and specific injections. Surgery is often the best and most effective option when dealing with this form of arthritis.

Total shoulder arthroplasty – or total shoulder replacement – is where the shoulder is replaced with an artificial joint using metal components for the bones and durable polymer pieces to replicate cartilage.

One popular form of shoulder replacement is the reverse total shoulder surgery. Reverse total shoulder surgery is where the anatomy is switched; the ball of the humerus is turned into a cup and the cup of the glenoid cavity – shoulder cup – is turned into a ball. This change allows for greater leverage and actually improves upon the body’s natural function. Patients with high degrees of arthritis will experience the best results with the reverse total shoulder replacement procedure and are more likely to have significant improvement in arm mobility.

The reverse total shoulder replacement not only improves function and reduces pain for those in end-stage osteoarthritis, but also those who have experienced prior failed shoulder replacements, have deep tendon/rotator cuff issues, or have fractures of the humerus which require joint replacement.

Depending on the condition of the joint or complexity of the arthritis, arthroscopy may also be performed to better diagnose the shoulder pain.

Shoulder pain and stiffness should not be ignored. Early detection of osteoarthritis allows for more available treatments.

Published: Wednesday, August 12, 2020