Shoulder Arthropathy

Shoulder arthritis is damage to the cartilage inside the shoulder joint, it has two joints. Shoulder arthritis usually refers to the bigger ball-and-socket joint named the glenohumeral joint as it connects the glenoid and humerus. The cartilage covers both the ball i.e the humeral head and the socket i.e. the glenoid.
When the cartilage in the shoulder begins to break down on the surface and also in the deeper layers, it’s called shoulder arthritis. The other joint in the shoulder, the acromioclavicular or AC joint, can also develop arthritis.

STAGES OF SHOULDER ARTHROPATHY
Shoulder arthritis typically develops in stages.

• The cartilage becomes soft then it develops cracks in the surface.
• Begins to fibrillate i.e.deteriorate and flake.
• Then wears away to expose the surface of the bone
• Finally loses its ability to act as a smooth, gliding surface.

Individuals have different degrees of damage to the cartilage. Certain activities may produce pain, as the cartilage experiences stress, because these activities are more likely to damage the cartilage and the shoulder joint further.

There are several forms of shoulder arthritis and each type can have different causes:

• Osteoarthritis or degenerative joint disease. This disease is associated with wear and tear related to aging.
• Rheumatoid arthritis is an autoimmune disorder, in which the body attacks its own healthy cells, which may include the lining of the joint.
• Post-traumatic shoulder arthritis occurs if the shoulder was dislocated, fractured, o injured, you may develop post-traumatic arthritis.
• Rotator cuff tear arthropathy is a type of shoulder arthritis that can develop due to a prolonged rotator cuff tear. The four rotator cuff tendons in the shoulder wrap around the ball portion of the shoulder joint, holding it in place. If anyone or more of these tendons are torn heavily, then this may cause the humeral head to rub against other bones and develop arthritis.
• Avascular necrosis refers to the disrupted blood supply to an area of the body, it results in that area dying i.e.necrosis. In the shoulder, the humeral head may lose blood supply due to disease, traumatic injuries, etc. Without a blood supply, the bone will slowly collapse, becomes uneven, and causes arthritis.

The amount of cartilage loss varies from person to person and so do symptoms of shoulder arthritis. The most common symptom of arthritis of the shoulder are:

• Pain aggravated by activity and progressively gets worse over time.
• Condition may intensify with changes in the weather.
• Deep ache in the joint.
• Shoulder stiffness.
• Might radiate or travel to the side of the neck.
• Limited movement of the shoulder.
• Night pain is common with sleep disturbance.
• Difficult to lift the arm while combing the hair or even reaching up to a shelf.
• Crepitus, grinding, clicking, or snapping sound while moving the shoulder.
• Sometimes the crepitus is painful and can be loud enough for other people to hear.

Pathology
Shoulder arthropathy is a degenerative joint disease that involves: (a). The cartilage in the joints breaks down. (b). Abnormal bony growths like bone spurs or osteophytes, develop in the joint.

Physical Examination
The examiner will discuss the symptoms and medical history and also examine the shoulder.
During the physical examination, the examiner will look for weakness or atrophy in the muscles, tenderness, extent of passive and active range of motion, signs of injury to the muscles, tendons, and ligaments surrounding the joint, crepitus with movement, provocation of pain when pressure is applied on the joint.

X-Rays:
X-rays create detailed pictures of dense structures, like bone, and help to distinguish among various forms of arthritis. X-rays of an arthritic shoulder show a narrow joint space, changes in the bone, and the formation of osteophytes.

Bone scan:
A bone scan also helps to determine the condition of the bone and soft tissues of the joint which helps in the diagnosis of shoulder arthropathy.

Medication: Acetaminophen, NSAIDs, Corticosteroid injections
Note: Medication should not be taken without the doctor’s prescription.

Surgery:
Surgery is recommended if the pain causes disability and is not relieved by nonsurgical treatment. Surgeries done are as follows:

• Arthroscopy. 
• Shoulder joint replacement (arthroplasty). 
• Hemiarthroplasty. 
• Total shoulder arthroplasty.
• Reverse total shoulder arthroplasty.
• Resection arthroplasty. 
• Reverse total shoulder replacement.

Rest:
Rest or change in activities. The patient should take rest and also change the way he moves his arm to avoid provoking pain.

Thermotherapy:
Moist heat may provide temporary relief. Heat is a better treatment for shoulder arthropathy and is good for warming up the joint before stretching.

Cryotherapy:
The patient is recommended to apply ice to the shoulder for 20 to 30 minutes two or three times a day to reduce inflammation and ease pain. Ice therapy can be used once or several times a day if needed. It can be applied in a bag or as a pad that can be placed in the freezer and reused. The ice pack should be placed on the top, on the front, and on the back of the shoulder for 20-30 minutes at a time. If the pain wakes up the patient at night, then consider icing the shoulder before bed.

TENS:
Transcutaneous electrical stimulations (TENS), are electrical stimulations that are applied through pads placed on the skin, to relieve pain.

Hydrotherapy:
Water exercises are useful exercises that increase the range of motion by immersing the body in water and allowing weight-bearing muscles to relax, and during this process simple range of motion exercises are performed.

Range of motion Exercises:
Physiotherapy exercises may improve the range of motion, strength, and function in your shoulder. Range-of-motion exercises keep the shoulder mobile. But if the range of motion is not affected, then the main aim is to prevent it from further deteriorating.

Stretching Exercises:
Due to joint stiffness, the pain and the ability of the shoulder joint to be active may also worsen. Therefore, stretching exercise is recommended for two to three minutes every day, whether the patient has a loss of motion or not.

Strengthening Exercises:
Strengthening the shoulder with arthritis is recommended if the exercises don’t cause more pain.If these exercises do not bother the shoulder, then they are perfectly fine to do.

Recovery time and rehabilitation depend upon the type of surgery performed. The patient is advised to avoid activities that make shoulder pain. if the shoulder pain lasts for several days and wakes you up at night, then it is necessary to decrease the frequency of the activity to once a week instead of daily.