Shoulder and Elbow Arthritis

Causes of Shoulder and Elbow Arthritis

Arthritis causes pain, stiffness and loss of function. The most common cause of shoulder and elbow joint pain is osteoarthritis, also called wear and tear arthritis as it is more common as we age. This condition leads to the cartilage lining the joints becoming rough and beginning to wear away. The bones may rub together causing pain and sometimes leading to the development of bony spurs. Other forms of arthritis that affect the shoulders and elbows include: rheumatoid arthritis which is an autoimmune condition that results in swelling and erosion of the joint linings; posttraumatic arthritis which occurs after a serious injury; rotator cuff arthropathy which is arthritis of the shoulder following a severe rotator cuff tear; and avascular necrosis which is damage to the joint resulting from an interruption in the blood supply.

Symptoms of Shoulder and Elbow Arthritis

Arthritis is characterised by pain, stiffness and a loss of strength and function in the affected joint. You may also hear a cracking sound or feel a grinding sensation when you move. Arthritis symptoms tend to worsen as the joint deteriorates and may be particularly bad at night which can impact sleep. Sometimes bony spurs (osteophytes) form at the edges of the joint and these may cause joint impingement or catching when you move the joint. Elbow osteoarthritis tends to put pressure on the ulnar nerve which may cause numbness in the ring finger or little finger. Because arthritis is a painful, degenerative condition it can have a significant impact on quality of life, making it hard to perform even simple everyday activities. Sometimes, this can lead to feelings of depression, particularly as the disease becomes more advanced.

Diagnosis of Shoulder and Elbow Arthritis

Your doctor will carry out a physical examination, testing the affected joints for pain, weakness and loss of function. An X-ray may help to determine how advanced the condition is (indicated by a narrowing of the joint space) and to check for bony spurs. In some cases a CT or MRI scan may be used to assess damage to the bones or the cartilage lining the joint.

Treatment of Shoulder and Elbow Arthritis

In the early stages, we normally recommend non-surgical treatment for arthritis. Painkillers and anti-inflammatories can be used to manage the pain and an exercise programme devised by a physiotherapist or occupational therapist can help you to build muscle strength and find alternative ways to perform everyday activities.  If you have rheumatoid arthritis, a Rheumatologist will be able to prescribe drugs to control your condition. Therapeutic injections are an effective way to manage mild to moderate pain from arthritis. An injection of steroids into the affected joint can help to reduce inflammation, while injections of hyaluronic acid may be given to lubricate the damaged joint.

In the latter stages, surgery may be the most effective ways to manage worsening symptoms. There are various different techniques and your orthopaedic surgeon will advise on which may be the best for you. We routinely carry out:

• Debridement which involves removing rough bone surfaces and any debris and releasing tight tissues that are causing joint stiffness.  It is normally carried out arthroscopically (using keyhole surgery) but may also be performed as open surgery.
• Joint replacement surgery. In the most severe cases, the diseased joint is removed and replaced with a prosthetic implant. Shoulder replacement surgery may be anatomic (replacing the ball and socket joint like-for-like with an artificial implant) or reverse (swapping the socket for a ball that is attached to the shoulder blade and placing the cup at the top of the arm bone). A reverse shoulder replacement is used if there is damage to the rotator cuff. Sometimes only the ball at the top of the humerus is replaced with a prosthetic implant. This procedure is called hemiarthroplasty.