Arthritis is a group of diseases that can cause swelling, pain, stiffness, and decreased range of motion in the joints. It’s the leading cause of disability in the United States, and it can affect people of all ages. Symptoms range from mild to severe and may come and go in some patients. There are many different types of arthritis, but there are three primary categories that impact the shoulder and elbow.
Osteoarthritis
Most of the time when people say arthritis, they mean osteoarthritis. It’s the normal wear and tear type of arthritis that typically affects older adults, although younger people can also have osteoarthritis. It’s a slow process that develops over years, and once it starts, it can’t be reversed.
Many people with osteoarthritis have a strong genetic predisposition. It’s not directly genetic, but it does tend to run in families. This type of arthritis primarily affects the large joints, like the hips, knees, and shoulders. Osteoarthritis of the elbow is not very common, whereas osteoarthritis of the shoulder is.
Osteoarthritis can affect multiple joints at one time. Typically, treatment begins with non-operative approaches to try and preserve the joint as long as possible. That may include cortisone injections, physical therapy, activity modification, use of assistive devices, or anti-inflammatories.
For osteoarthritis of the shoulder, steroid injections can often be effective for a while to decrease the pain and allow for continued function. In other joints, such as the knee, a viscosupplementation to inject lubricating fluid into the joint may be used, but that treatment is not FDA approved for shoulders and research hasn’t shown it to be effective for shoulders.
As arthritis progresses, an individual may be unable to complete normal daily activities or may be in so much pain that narcotic pain medications are required. At that point, when non-operative treatment is no longer giving sufficient relief, it may be time to talk to your doctor about surgical options, including joint replacement. More than 50,000 shoulder replacements are done each year in the US.
Inflammatory arthritis
There are many types of autoimmune and inflammatory arthritis, including rheumatoid and psoriatic arthritis. In this type of arthritis, the body is attacking its own cells, which causes inflammation, pain, and stiffness. Rheumatoid arthritis (the most common type of inflammatory arthritis) typically attacks the smaller joints, such as the hands and elbow. Shoulders are less commonly impacted by rheumatoid arthritis, although it is possible.
In treating inflammatory arthritis, the goal is to preserve the joints as long as possible, since this type of arthritis can affect patients at a much younger age. Most patients in this category see a rheumatologist for primary treatment with medication. Newer medications developed in the past 10 to 15 years work very well for controlling the disease and helping prevent the need for joint replacement. However, if a patient does have advanced joint destruction from inflammatory arthritis, the treatment options are usually the same as those mentioned above for osteoarthritis.
Post-traumatic arthritis
This type of arthritis is much less common, but it occurs when a fracture line extends into the joint following some sort of trauma, such as a car accident or fall. This results in incongruity of the joint line, which means the surface is uneven and does not glide smoothly against the other side of the joint. Over time, this leads to damage to the cartilage lining on both sides of the joint, and these joints develop end-stage arthritis.
Frequently, this type of arthritis is not very responsive to the conservative managements listed above in the osteoarthritis section, and patients may need surgery for definitive treatment. Also, deformities (abnormal shape of the bone) and/or bone loss from the injury can affect the surgical options, including type of implant, in these patients.
Not long ago, the most common reason for an elbow replacement was rheumatoid arthritis. Due to advancements in the medical management of rheumatoid arthritis, including medications called DMARDs (disease-modifying antirheumatic drugs), post-traumatic arthritis has become the leading reason for elbow replacements.
If you are experiencing shoulder or elbow pain and stiffness and suspect arthritis may be the cause, contact the Oklahoma Shoulder Center today to schedule an appointment.
By Oklahoma Shoulder Center PLLC
December 30, 2017
