World Arthritis Day 2022: Heres All You Need To Know About Its Prevention & Treatment

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World Arthritis Day 2022: Here's All You Need To Know About Its Prevention & Treatment

There is a lot of public awareness about arthritis of hip and knee joint, but very little about arthritis of the shoulder joint which is not as uncommon as what people think it is.

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Arthritis refers to the wearing down of the joint, when the smooth surface lining the end of the bones (cartilage) wears down causing the rough bone ends to rub against each other causing pain and stiffness. There is a lot of public awareness about arthritis of hip and knee joint, but very little about arthritis of the shoulder joint which is not as uncommon as what people think it is.

Arthritis of the shoulder is third most common after Knee and Hip Arthritis. Rather, often arthritis of the shoulder is misdiagnosed as frozen shoulder by even orthopedic surgeons and people spend years doing mobilization exercises and taking medicines without any relief from Pain and stiffness. The routine questions regarding Why does shoulder develop arthritis, How do I know if my shoulder pain is due to Arthritis and What to do after I have been diagnosed as having arthritis of the shoulder are largely unanswered and hence this little piece of information.

Why Does Shoulder Develop Arthritis?

  • Ageing – As it is with Hip & Knee Arthritis, Shoulder undergoes wear and tear as you age, though it is not as predictable as it is with other two joints and we often encounter people more than 80 years old with pristine shoulders. Largely, Senile arthritis of the shoulder happens often because of the dysfucntion of muscles forming rotator cuff which causes eccentric forces across the shoulder joint accelerating its wear and tear.
  • Injury – Fractures & more commonly tear of the rotator cuff muscles can cause arthritis
  • Infection – Particularly, Tuberculosis is a common cause of arthritis of shoulder esp in the Indian subcontinent.
  • Inflammatory Arthritis – Shoulders being synovial joints like Hip & Knee can be secondarily involved in Rheumatoid Arthritis & Ankylosing Spondylitis.

How Do I Know If My Shoulder Pain Is Due To Arthritis?

Most people with arthritis of the shoulder complain of pain and stiffness of the shoulder. The pain mainly bothers them at night. This symptom complex is not specific to shoulder arthritis. This also happens in the more common problems of Frozen shoulder and Rotator Cuff dysfunction, however, one complaint that is unique to arthritis of the shoulder is the grating and crackling noise from your shoulder whenever you move it.

In the majority of cases, x-rays are sufficient to establish the diagnosis, but then proper views should be obtained. Your doctor must direct the radiographers to a True AP / Axial view of the shoulder. The routine shoulder x rays are oblique projections and the arthritis of the shoulder joint may not be apparent on them.

A good clinical examination from your doctor would supplement the x rays in establishing the diagnosis of Arthritis of the shoulder.

What To Do Once I Have Been Diagnosed With Arthritis Of Shoulder

Like Hip & Knee Arthritis, once the shoulder becomes arthritis and undergoes extensive wear and tear, it will not recover on its own. The damage is irreversible and this brings us to the burning question that is surgery inevitable in case of arthritis of the shoulder.

The answer to this is ' Maybe'. Shoulder is not a weight bearing joint, unlike Hip & Knee and hence, different people have varying magnitude of pain and limitation of movements with the same extent of arthritis. Lot of people can spend their entire lifetime comfortably with just activity modification and as on when needed painkillers.

Activity Modification – This is the most important thing in management of shoulder arthritis. One should keep on moving the arthritic shoulder as undue rest would increase the stiffness of the shoulder and hence the pain, but at the same time, one should avoid lifting anything heavy such as a bag full of groceries or a bucket full of water.

You can use the shoulder for daily activities such as grooming, eating etc but one needs to avoid strenuous activities which involve repeated motions such as brooming / cleaning the floor etc.

Simple precautions such as supporting the elbow on a sofa / table etc. When talking on a mobile phone or typing would take off load from your worn out shoulder and prevent any pain.

Medicines – The arthritis of the shoulder undergoes periods of exacerbation and remission, which means that there are times when the shoulder becomes very painful and there are times when your shoulder is as good as new one. During an exacerbation, one needs to take pain killers, apply ice and any ointment containing diclofenac. There is no strong evidence supporting the role of chondro supplements ( Glucosamine, Collagen, Hyaluronic Acid etc. ) in the treatment of arthritis of the shoulder.

Injections in the Joint – Corticosteroid Injections are valuable adjuncts in the management of shoulder arthritis especially when it's painful and swollen. They bring quick pain relief, allowing your muscles to act and enabling you to move your shoulder. However, they have their limitation of limited duration of action ( 2-3 months ), increase in blood sugar levels ( especially in people with Diabetes ). As mentioned previously, there is limited role of Hyaluronic Acid Injections in the joint. PRPP injections in the shoulder joint are still in an experimental phase and not much can be commented upon for their efficacy.

Surgery – Indicated for those who fail conservative treatment in form of activity modification, painkillers and repeated steroid injections in the shoulder joint. Like other joints, the definitive treatment of Arthritis of Shoulder is Joint Replacement surgery ( Arthroplasty ) but unlike Hip and Knee, there are 2 different kinds of Arthroplasty of shoulder depending upon the integrity of muscles around the shoulder joint. If the rotator cuff muscles are intact, then Total Shoulder Replacement has predictable, good results with an average lifespan of 15 years. However, as what happens in most of the cases, either the rotator cuff muscles are torn or they are too thin to act efficiently. In that case, people would benefit from Reverse Polarity Shoulder Replacement.

This kind of replacement is unique to shoulder as this is the only kind of surgery in the entire body where the anatomy is reversed. This means, that the artificial socket is placed where the Ball ( Head of Humerus ) was originally and the Artificial Ball is placed where the socket ( Glenoid ) was present originally. Though technically difficult, this surgery has fairly good results if done by good hands.

Like we always say, prevention is better than cure. Timely treatment of other shoulder pathologies such as muscle tear, fractures, infections etc is the key to healthy shoulders and prevents undue damage and wear & tear of shoulder joints. Besides, it's important to keep the muscles around the shoulder healthy by exercises, yoga etc. Also, senior citizens should avoid exercises which involve weight bearing on the shoulder such as Planks, Pushups, Headstand etc.

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Creatives : Ankita Singh

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