Gleno-humeral Joint Arthritis
What is this:
This refers to wearing away of the cartilage at the ball and socket joint of the shoulder. It can be caused by inflammatory process (like rheumatoid arthritis), age-related wear (osteoarthritis) or damage due to injury (post-traumatic arthritis). Shoulder arthritis can also occur secondary to rotator cuff disease (Cuff Tear Arthropathy) or softening of humeral head due to loss of blood supply (Avascular Necrosis).
Symptoms:
- Pain: This is felt in and around the shoulder and can also occur in the arm, elbow, muscles of shoulder girdle or neck. Pain is usually noted with physical activities or movements. In severe cases, it can occur at night.
- Stiffness or loss of movements: In early arthritis this causes difficulty in overhead activities and reaching the the back. In severe cases there is extreme restriction of movements associated with pain.
- Crepitus: creaking or grinding sensation on moving the arm.
- Severe degree of arthritis (end-stage disease) results in pain, stiffness and extreme disability.
Diagnosis:
Diagnosis: is made on noting the history, physical examination and X-ray findings. X-rays may not reveal arthritis till it is quite advanced. MRI scans are more accurate in detecting the arthritis and assessing its severity.
Treatment of early arthritis:
- Gentle exercises
- Modification or restriction of painful activities
- Application of hot packs or ice packs or analgesic gels
- Physiotherapy
- Analgesics
- Steroid and hyaluronic acid injections can also be tried. However, these do not give complete or lasting relief and may have to be repeated. There is a risk of infection of the joint with these injections. Therefore, they are better avoided.
Treatment of advanced arthritis:
- Treatment of end-stage arthritis is by shoulder joint replacement.
- Various types of replacement are being done.
- The choice will depend on the patient’s condition, the status of the rotator cuff and surgeon’s preference.
- Pain relief is excellent. Functional improvement is also very good following replacement surgery.
- Types of shoulder replacement:
- Total shoulder replacement: This is the standard replacement for shoulder arthritis. This needs adequate rotator cuff function to work properly. It gives good to excellent results in terms of pain relief and restoration of function. It is long-lasting.
- Reverse shoulder replacement: This is done when the rotator cuff is non-functional or severely damaged. It is also recommended for multi-fragmentary fracture of the humerus in the elderly who have poor bone quality. In this prosthesis, the ball and socket are located in a reverse fashion. This operation gives excellent results with respect to pain relief and functional improvement. It is also long-lasting.
- Hemi-arthroplasty: In this operation, only the ball is replaced. It gives reasonably good results. This is used when the wear of the socket is mild. It is also done for milti-fragmentary fractures of the humeral head. It is also used as a salvage procedure in failed replacements and severely damaged rotator cuff.
- Humeral head resurfacing (cup arthroplasty): In this operation only the surface of the humeral head is replaced by a shell. This needs adequate rotator cuff function for its success. In osteoporotic bone there is a risk of loosening. Hence it is done less commonly now-a-days.
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