The glenohumeral joint is between the arm bone and the shoulder blade. When affected by arthritis, the pain is deep, and the patient points to both sides of the shoulder usually grabbing his whole shoulder with his opposite hand. The shoulder is usually stiff especially trying to reach behind or above the head or behind the back. The patient usually experiences grinding, popping, and/or catching. Pain may occur at night making sleep difficult.
Upon examination, the shoulder is usually tender to deep pressure, and limited in motion. X-rays typically show narrowing of the space between the two bones, bone spurs, and cysts, signifying loss of the cartilage layer on the surface of the bones.
Initial treatment of arthritis of the shoulder is nonsurgical. Typically I offer my patients a steroid injection and antiinflammatory medicines.Activity modification is helpful. Physical therapy helps the patient gain functional motion and control the pain. Icing or heating pads may help as well.
If nonsurgical treatment is not effective, we may consider surgery. As with all surgeries, there are some risks and possible complications. Depending on the degree of damage, the patient’s age and functional demands, we have to choose between joint preserving procedures and joint replacement. Either way, the aim is to improve motion, strength, and limit pain.
ACJ Arthritis is very common, at least on x-ray. The ACJ is the joint between the collar bone and the tip of the shoulder blade. The mere presence that x-ray signs of arthritis at the ACJ does not necessarily mean that is is painful. When it is painful, the pain is focused on the top and maybe the front of the shoulder. Motion may be limited by pain, but the shoulder is not particularly stiff. The most difficult motion is reaching across to the other shoulder and reaching behind the back. ACJ arthritis is frequently accompanied by other problems in the shoulder, and it may only explain part of the pain. I usually offer an injection, which, at a minimal gives temporary relief. This temporary relief, (hours to days) is valuable as a diagnostic tool confirming the suspicion that the source of the pain is truly in the ACJ joint. On top of that, the injection may provide long term relief. Physical therapy usually has a limited role in ACJ arthritis. When necessary, surgery consists of removing the tip of the collar bone. This can be performed in an open or arthroscopic fashion.