The shoulder joint is made up of a ball (humeral head) and socket (glenoid). The surfaces of these 2 structures are lined by smooth cartilage which allows smooth, pain free shoulder movement. When the cartilage is worn away, the surfaces become rough and can cause pain. This condition is usually referred to as osteoarthritis of the shoulder. Osteoarthritis can occur on its own, or it can be secondary to another condition, e.g rheumatoid arthritis, massive cuff tears.
Osteoarthritis of the shoulder usually causes gradually progressive pain and stiffness. Ways to manage the pain include pain killers, activity modification, and occasionally cortisone injections. These methods will help control the pain in most patients with shoulder osteoarthritis but will not reverse the problem.
When the non-operative measures have failed, the patient can consider having an operation to help with the pain. There are a number of options depending on the type of arthritis present.
In younger patients with osteoarthritis, an arthroscopic release of the scar tissue in the tight stiff shoulder can serve to improve motion and pain by “decompressing” the shoulder joint and lowering the joint contact forces. This is a minimally invasive procedure which can be done as a day procedure.
When arthritis has progressed in the shoulder, other options include the various types of shoulder replacements. These include:
- Half shoulder replacement: (aka hemiarthroplasty)
- Shoulder resurfacing
- Stemmed shoulder hemiarthroplasty
- Total shoulder replacement
The type of shoulder replacement chosen depends on many factors including:
- The amount of bone in the socket
- The presence of a rotator cuff tear
- The age and activity level of the patient
A careful discussion between the surgeon and the patient is important to understand the possible options and most suitable choice for each patient.