Arthritis of the Shoulder and Arm

Arthritis of the Shoulder and Arm

Arthritis of the shoulder and arms refers to the inflammation and degeneration of the joints in these areas. It can cause pain, stiffness, swelling, and reduced range of motion, affecting the overall function of the shoulder and arms. 

Shoulder arthritis is also named as glenohumeral joint as the bones get connected to the glenoid and humerus. The cartilage covers both the ball and the socket. When the breakdown of cartilage happens in the deeper layers it is known as shoulder arthritis. The second joint in the shoulder called as acromioclavicular or AC joint can also get affected due to connectivity with shoulder arthritis.

Types of Arthritis Affecting Shoulder and Arm

Shoulder and arm arthritis can manifest in different forms. The two most common types of arthritis that can affect the shoulder and arm are osteoarthritis and rheumatoid arthritis. However, there are other less common types as well. Here are the main types of shoulder and arm arthritis –

1. Osteoarthritis – This is the most common type of arthritis and occurs due to wear and tear of the joint cartilage over time. It can affect the shoulder joint, causing pain, stiffness, and reduced range of motion. Osteoarthritis usually develops with age or as a result of joint injury or repetitive stress.
2. Rheumatoid arthritis – Rheumatoid arthritis is an autoimmune condition in which the body’s immune system mistakenly attacks the joint lining, causing inflammation. It can affect multiple joints, including the shoulder and arm. Rheumatoid arthritis often leads to joint pain, swelling, stiffness, and reduced mobility.
3. Psoriatic arthritis – Psoriatic arthritis is a type of arthritis that commonly occurs in people with psoriasis, a chronic skin condition. It can affect various joints, including those in the shoulder and arm. Symptoms may include joint pain, swelling, stiffness, and skin lesions.
4. Septic arthritis – Septic arthritis occurs when a joint becomes infected, often due to bacteria entering the joint through an injury or bloodstream. While septic arthritis can affect any joint, it can occasionally involve the shoulder or arm joints. It causes severe pain, swelling, redness, and warmth in the affected joint.
5. Gout – A gout is a form of arthritis caused by the buildup of uric acid crystals in the joints. It commonly affects the big toe but can also involve other joints such as the shoulder or elbow. Gout flare-ups cause sudden and severe joint pain, swelling, redness, and tenderness.
6. Post-traumatic arthritis –  This type of arthritis can develop after an injury or trauma to the shoulder or arm, such as a fracture, dislocation, or severe sprain. The initial injury may lead to joint instability, cartilage damage, and subsequent arthritis symptoms, including pain, stiffness, and limited mobility.
7. Frozen shoulder (adhesive capsulitis) – While not true arthritis, frozen shoulder is a condition characterized by inflammation and tightening of the shoulder joint capsule. It can cause significant pain and restricted range of motion in the shoulder.

Proper diagnosis and treatment should be sought from a healthcare professional, such as a rheumatologist or orthopedic specialist, to determine the specific type of arthritis and develop an appropriate management plan.

Symptoms

The symptoms of shoulder and arm arthritis can vary depending on the specific type of arthritis and the severity of the condition. However, some common symptoms experienced by individuals with shoulder and arm arthritis include –

1. Joint pain – Persistent pain in the shoulder joint, arm joints (such as the elbow or wrist), or surrounding areas is a common symptom. The pain may be dull, aching, or sharp and may worsen with movement or activity.
2. Stiffness – Stiffness in the affected joints, especially in the morning or after periods of inactivity, is a typical symptom. It can make it challenging to move the shoulder or arm joints freely.
3. Swelling – Inflammation and swelling may occur in the affected joints, leading to visible swelling and a feeling of fullness or tightness in the shoulder or arm.
4. Limited range of motion – Arthritis can result in reduced flexibility and range of motion in the shoulder and arm joints. It may become difficult to perform everyday tasks or reach certain positions due to this limited mobility.
5. Weakness – Weakness in the affected shoulder and arm muscles may develop, making it challenging to lift or carry objects or perform certain activities that require strength.
6. Clicking or grinding sensation – Some individuals with shoulder and arm arthritis may experience a clicking, popping, or grinding sensation when moving the affected joints. This is often caused by the roughened or damaged joint surfaces rubbing against each other.
7. Tenderness – The affected joints may become tender to the touch, and pressure applied to the area may cause discomfort or pain.
8. Fatigue – Arthritis-related pain and inflammation can contribute to fatigue, making it harder to perform daily activities.
9. Joint deformity – In some cases, chronic and severe arthritis can lead to joint deformities, such as a visible change in the shape or alignment of the shoulder or arm joints.

These symptoms can also be present in other conditions affecting the shoulder and arm, so it is crucial to consult with a healthcare professional for a proper evaluation and diagnosis. They can provide an accurate diagnosis and recommend appropriate treatment options to manage the symptoms and improve overall joint function.

Causes

The causes of arthritis can vary depending on the type of arthritis. Here are some common causes associated with different forms of arthritis –

1. Osteoarthritis (OA) – The exact cause of OA is not fully understood, but it often develops due to a combination of factors, including age, genetics, joint injury or trauma, repetitive stress on the joints, obesity, and abnormal joint alignment.
2. Rheumatoid Arthritis (RA) – RA is an autoimmune disease, which means that the immune system mistakenly attacks the body’s own healthy tissues, including the joints. The exact cause of RA is unknown, but it is believed to involve a combination of genetic and environmental factors, such as certain infections or hormonal changes.
3. Psoriatic Arthritis (PsA) – PsA is associated with the skin condition psoriasis. It is believed to result from an abnormal immune response and genetic factors. Psoriasis itself is thought to be triggered by a combination of genetic, immune, and environmental factors.
4. Gout – Gout is caused by the buildup of uric acid crystals in the joints. It occurs when the body produces excessive amounts of uric acid or has difficulty eliminating it. A diet high in purines (found in certain foods like red meat and seafood), alcohol consumption, obesity, and certain medical conditions can contribute to the development of gout.
5. Juvenile Idiopathic Arthritis (JIA) – The exact cause of JIA is unknown, but it is believed to involve a combination of genetic, environmental, and immune system factors. In some cases, JIA may be triggered by an infection.
6. Ankylosing Spondylitis (AS) – AS has a strong genetic component, with a specific gene called HLA-B27 being associated with an increased risk. However, environmental factors and the immune system also play a role in its development.
7. Systemic Lupus Erythematosus (SLE) – SLE is a complex autoimmune disease with no known single cause. It is believed to result from a combination of genetic, hormonal, and environmental factors, including infections, certain medications, and sun exposure.
8. Reactive Arthritis – Reactive arthritis is typically triggered by an infection, often in the urinary or gastrointestinal tract. Bacterial or viral infections, such as sexually transmitted infections or foodborne illnesses, can contribute to the development of reactive arthritis.

The causes of some types of arthritis are still not yet known and more research is needed to uncover the underlying mechanisms. Additionally, there are other less common types of arthritis with their own specific causes. Consulting with a healthcare professional is crucial for an accurate diagnosis and understanding of the underlying causes of arthritis.

Risk Factors

Several risk factors can contribute to the development of arthritis in the shoulder and arm. These factors can increase the likelihood of developing arthritis or accelerate its progression. Here are some common risk factors associated with arthritis of the shoulder and arm –

1. Age – The risk of developing arthritis, including osteoarthritis, increases with age. As people get older, the wear and tear on the joints accumulate, leading to a higher risk of joint degeneration and arthritis.
2. Gender – Certain types of arthritis, such as rheumatoid arthritis, are more prevalent in women. However, both men and women can develop arthritis in the shoulder and arm joints.
3. Previous joint injuries – Previous injuries to the shoulder or arm joints, such as fractures, dislocations, or ligament tears, can increase the risk of developing arthritis later in life. These injuries may disrupt the normal structure and function of the joint, leading to accelerated joint degeneration.
4. Repetitive use or overuse – Engaging in activities that involve repetitive movements or overuse of the shoulder and arm joints, such as repetitive lifting, throwing, or overhead motions, can increase the risk of developing arthritis. These activities can cause excessive stress on the joints, leading to joint damage over time.
5. Genetics – Family history and genetics can play a role in the development of arthritis. Certain genes have been associated with increased susceptibility to different types of arthritis, including those affecting the shoulder and arm joints.
6. Autoimmune conditions – Autoimmune conditions, such as rheumatoid arthritis or psoriatic arthritis, increase the risk of developing arthritis in various joints, including the shoulder and arm. In these conditions, the immune system mistakenly attacks the body’s own tissues, leading to joint inflammation and damage.
7. Obesity – Excess weight puts additional stress on the joints, including the shoulder and arm joints. The increased load can accelerate joint degeneration and increase the risk of developing arthritis.
8. Infection – Infections in the shoulder or arm joints, such as septic arthritis, can lead to joint inflammation and subsequent arthritis. Infections can occur due to injury, surgery, or the spread of bacteria through the bloodstream.
9. Systemic diseases – Certain systemic diseases, such as rheumatoid arthritis, lupus, or gout, can affect multiple joints in the body, including the shoulder and arm joints.

Having one or more of these risk factors does not guarantee the development of arthritis, but it may increase the likelihood. By understanding these risk factors, individuals can take preventive measures and adopt lifestyle modifications to reduce the risk or manage arthritis symptoms effectively.

Diagnosis and Tests

The diagnosis of shoulder and arm arthritis typically involves a combination of medical history assessment, physical examination, imaging tests, and sometimes laboratory tests. Here are the common diagnostic methods used for diagnosing shoulder and arm arthritis –

1. Medical history and physical examination – The healthcare provider will review your medical history, including any symptoms you are experiencing and factors that may contribute to arthritis development. During the physical examination, they will assess your range of motion, joint tenderness, swelling, and joint stability.
2. X-rays – X-rays can help visualize the bones and joints, allowing the healthcare provider to assess the joint space, bone spurs, joint deformities, and other signs of arthritis. X-rays may reveal osteoarthritis-related changes, such as joint narrowing or the presence of osteophytes (bone spurs).
3. Magnetic Resonance Imaging (MRI) – An MRI scan provides detailed images of the soft tissues, including the joint structures, such as cartilage, ligaments, and tendons. It can help evaluate the extent of joint damage, inflammation, and the presence of other conditions that may affect the shoulder and arm joints.
4. Ultrasound – Ultrasound uses sound waves to create real-time images of the joints. It can help assess the joint structures, detect inflammation, and guide the needle placement for joint aspirations or injections.
5. Blood tests – While there is no specific blood test to diagnose most types of arthritis, blood tests can be helpful in evaluating inflammatory markers and ruling out other potential causes of joint symptoms. For example, blood tests may be conducted to check for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies in suspected cases of rheumatoid arthritis or uric acid levels in suspected gout.
6. Joint aspiration (arthrocentesis) – In certain cases, the doctor may perform a joint aspiration to collect fluid from the affected joint for analysis. The fluid can help determine the cause of joint inflammation, such as infection or crystal-induced arthritis.
7. Other specialized tests – In some instances, additional tests, such as a bone scan or CT scan, may be recommended to evaluate specific concerns related to the shoulder and arm joints.

It’s necessary to consult with a healthcare professional, such as a rheumatologist or orthopedic specialist, for an accurate diagnosis of shoulder and arm arthritis. They will consider the clinical findings, imaging results, and test outcomes to provide an appropriate diagnosis and develop an individualized treatment plan.

Treatment

The treatment of shoulder arthritis aims to alleviate pain, reduce inflammation, improve joint function, and enhance the individual’s quality of life. The specific treatment options recommended for shoulder arthritis depend on factors such as the type and severity of arthritis, the patient’s overall health, and their individual preferences. Here are some common approaches to treating shoulder arthritis –

1. Medications

a. Nonsteroidal anti-inflammatory drugs (NSAIDs) – These medications help reduce pain and inflammation in the shoulder joint.

b. Analgesics – Pain relievers like acetaminophen can provide temporary relief from arthritis-related shoulder pain.

c. Corticosteroids – Corticosteroid injections directly into the shoulder joint can help alleviate pain and inflammation.

2. Range of motion exercises – It often starts with a range of motion exercises to keep the shoulder mobile. Loss of motion in the shoulder due to arthritis can cause joints to stiffen, and the ability to be active may also get worsen. It’s recommended to stretch two to three times a day or whenever you feel a loss of motion. Physical therapy is not recommended unless you are losing a range of motion. In addition to that, strengthening the shoulder with a workout should be avoided as it can result in pain increase.

3. Lifestyle changes – The second medical treatment to consider is avoiding things that cause shoulder pain. For eg – If a regular golf activity results in everlasting pain for days or weeks it may be necessary to slow down especially if the pain interferes with your life. 

4. Injections for shoulder arthritis – There are two types of injections that are used to treat shoulder arthritis including –

a. Cortisone shots – cortisone is usually mixed with a numbing agent that helps in providing immediate pain relief which helps your doctor know if the injection is placed correctly at the affected site. Once, the injection wears off, the joint will become sore until cortisone kicks in. It is recommended to avoid replacement surgery for at least three months after a cortisone shot and also it is advisable to avoid the shot if you’re considering getting surgery soon.

b. Synthetically Manufactured Hyaluronic acid – It’s a naturally produced lubricant that helps in shoulder pain relief. These injections shot helps in the reduction of pain to a huge extent and also the benefits of it will last for around two years depending on the person’s condition.

5. Shoulder Surgery – When the other non-surgical options are not proving to be effective then the shoulder surgery is considered for a much better outcome. There are two types of surgery recommended by doctors for shoulder pain including –

a. Arthroscopic Shoulder Debridement – It is a minimally invasive procedure that is performed with the help of a camera and surgical tool inserted into the joint to clean out the affected area of cartilage. This surgery is usually performed for lower-grade arthritis and not for bone-to-bone fraction areas. The operation is considered a success if the patient receives pain relief within 12 to 24 hrs after the surgery is performed.

b. Shoulder Replacement – It is usually recommended for patients with bone-to-bone fraction disease. The surgery shows a significant improvement in providing pain relief and it is observed that results will last for several years ahead. There are two types of shoulder replacement including –

• Standard Total Shoulder Replacement – which replaces the ball and socket part of the shoulder joint with artificial parts.
• Reverse Total Shoulder Replacement – The ball and socket side of the joint switch places. 

6. Complementary and alternative therapies – Some individuals find relief from shoulder arthritis symptoms through complementary approaches such as acupuncture, massage therapy, or transcutaneous electrical nerve stimulation (TENS). However, the effectiveness of these therapies varies, and it’s important to discuss them with a healthcare professional.

7. Complementary and alternative therapies – Some individuals find relief from arthritis symptoms through complementary approaches like acupuncture, massage, herbal supplements, or mind-body techniques. It’s necessary to consult with a healthcare professional before trying these therapies to ensure safety and efficacy.

Regular follow-up visits and open communication with healthcare professionals can help monitor the effectiveness of treatments and make necessary adjustments.

Outlook

The outlook for shoulder and arm arthritis varies depending on several factors, including the type and severity of arthritis, the individual’s overall health, the effectiveness of treatment, and adherence to lifestyle modifications. While arthritis is a chronic condition that cannot be cured, proper management can help control symptoms, improve joint function, and enhance the quality of life. 

The progression of arthritis in the shoulder and arm joints can vary from person to person. In some cases, the progression may be slow and relatively stable, while in others, it may be more rapid. Early diagnosis, prompt treatment, and consistent management can help slow down the progression of arthritis and minimize joint damage.

It’s necessary to consider that each person’s response to treatment and the progression of arthritis is unique. Some individuals may experience significant improvement and long-term control of symptoms, while others may require ongoing management and adjustments to their treatment plan.

While shoulder and arm arthritis may present challenges, with proper management, individuals can lead active and fulfilling lives. It’s important to consult with a healthcare professional for an accurate diagnosis, personalized treatment plan, and ongoing support in managing shoulder and arm arthritis.