As with most arthritic conditions, the initial treatment is almost always non-surgical. The principles of non-surgical treatment are:
Rest and activity modification
You may need a short period of rest and/or change the way you use your arm to limit activities that exacerbate shoulder pain.
Analgesia
Non-steroidal anti-inflammatory (NSAIDs) and paracetamol are a good start to controlling baseline pain. Long-acting pain killers overnight can be useful. Prolonged use of NSAIDs may irritate the stomach lining and lead to gastric ulcers – therefore they should be used for short periods under the guidance of your local doctor.
Physiotherapy
Both self-directed and guided physical therapy is useful to keep the shoulder joint supple and strengthen the rotator cuff, scapula stabilising, upper back and deltoid muscles. This may offload the arthritis pain made worse by muscle imbalance.
Cortisone injections
Cortisone injections when used correctly can dramatically reduce inflammation and arthritis pain. However, this is not a cure and the effect is generally temporary. No more than two injections are recommended per year. A plain X-ray of the shoulder should always be obtained prior to cortisone injection into the joint – as cortisone itself is associated with avascular necrosis (AVN) of the shoulder joint – and this needs to be excluded prior to the injection.
General health optimisation
Seeing your general practitioner and optimising your cardiovascular health, diabetes, blood pressure, and diet can all lead to improvement in overall health. It also makes you a better anaesthetic and surgical candidate should you require future surgery.
Surgical treatment
If your shoulder arthritis symptoms are not responding to non-surgical treatment then there are a number of surgical options:
Arthroscopy
In cases of mild shoulder arthritis, arthroscopic (keyhole) shoulder surgery may be used to target pain generators in the shoulder. These include:
- Biceps tendon
- Acromion spur and subacromial bursa
- Acrmioclavicuar joint (ACJ)
- Shoulder joint spurs
Arthroscopy will not eliminate arthritis, but treat areas that may be exacerbating your shoulder pain; this will delay the need for shoulder replacement surgery.
Joint Replacement
Partial joint replacement
- Just the humeral head (ball) is replaced
- This is uncommon and usually for younger patients and those with avascular necrosis (AVN)
Total joint replacement
Anatomical shoulder replacement
- Both the head of the humerus and the glenoid (socket) are replaced
- The head is replaced with a metallic ball
- The glenoid is replaced with a plastic socket
- The native anatomy and biomechanics of the shoulder are restored (hence this is called an anatomical shoulder replacement)
- This does require an intact and good quality rotator cuff tendons (as assessed on MRI)
Reverse Shoulder Replacement
- Both the head of the humerus and the glenoid (socket) are replaced
- The head is replaced with a plastic socket
- The glenoid is replaced with a metallic ball
- The native anatomy and biomechanics of the shoulder are reversed (hence this is called a reverse shoulder replacement)
- A reverse shoulder replacement does not require an intact rotator cuff; however, it does require a well functioning deltoid muscle.