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Shoulder joint arthritis

What is shoulder joint arthritis?

Glenohumeral joint osteoarthritis, often simply called shoulder arthritis, is a condition that affects the main shoulder joint. It can cause pain, stiffness, and reduced function, making everyday tasks challenging.

The shoulder joint, or glenohumeral joint, connects the upper arm bone (humerus) with the shoulder blade (scapula). Like all joints, it has smooth tissue called cartilage covering the ends of the bones. This cartilage helps the bones glide against each other. In osteoarthritis, this cartilage gradually thins, leading to pain and stiffness.

How Does It Develop?

Osteoarthritis is often called “wear-and-tear” arthritis because it usually develops over time as we age. However, other factors can contribute, including:

  • Previous Injuries: A shoulder injury can damage the joint, increasing the risk of arthritis later on
  • Overuse: Repeated use of the shoulder in activities like sports or certain jobs can accelerate cartilage breakdown
  • Genetics: If your family has a history of arthritis, you might be more prone to developing it
  • Rheumatological conditions: some auto-immune joint disorders affect the shoulder in particular which can accelerate the loss of cartilage and development of inflamtion.

As the cartilage thins, the joint becomes painful and inflamed. Over time this progresses to restricted movement, particularly rotating the shoulder inwards and outwards.

Symptoms of shoulder joint arthritis

The symptoms of shoulder joint osteoarthritis typically include:

  • Pain: This is usually the first symptom. It can be a dull ache or sharp pain, often worsening with activity and improving with rest.
  • Stiffness: You might find it hard to move your shoulder, especially after periods of inactivity.
  • Swelling: The joint may appear swollen or feel warm to the touch.
  • Crepitus: A grinding or clicking sensation when moving the shoulder.

Diagnosing shoulder joint arthritis

If you suspect you have shoulder arthritis, a visit to a healthcare provider is recommended. Following a detailed history and examination, investigations are usually used to confirm the diagnosis.  X-rays are the first line, however sometimes an MRI or CT scan may be needed for a more detailed view.

Managing shoulder joint arthritis

While there is no cure for osteoarthritis, several treatment options can help manage symptoms and improve quality of life:

1. Lifestyle Changes:

  •    Activity modification: Where possible try to avoid or minimise activities that exacerbate pain.
  •    Exercise prescription: Gentle exercises and stretching can maintain mobility and strengthen surrounding muscles. A physiotherapist can guide you in a safe and effective exercise routine.

2. Medications:

  •    Pain Relievers: Over-the-counter medications like paracetamol or ibuprofen (if appropriate and tolerated) can help manage pain and inflammation.
  •    Prescription Medications: For more severe pain, stronger pain relieving medication may be appropriate

3. Injection therapies:

  •  Previously corticosteroid injections were recommended, however there are concerns around the impact these may have on the health of the joint should a shoulder replacement be considered in the future, so many specialists do not routinely recommend these.
  •  Hyaluronic Acid Injections:  This treatment aims to improve joint lubrication and is commonly used in the knee and ankle.  The evidence on benefit in the shoulder is less certain so, again, many specialists do not routinely recommend these.
  • Suprascapular nerve block: The nerves which detect pain in the shoulder joint can be blocked for an extended period using an injection technique.  This has the benefit of significantly reducing pain, whilst avoiding the pitfalls of injection into the joint itself.  The procedure can be repeated if needed without any ongoing concerns so, for this reason, nerve block is recommended by many specialists.

4. Surgery:

  •  Arthroscopy:  A minimally invasive procedure to clean out the joint, however this is rarely of sustained benefit and often provides no better relief than a combination of the other options outlined above
  •  Shoulder Replacement: In severe cases, replacing the damaged joint with an artificial one might be the best option.  Previously the success of this type of joint replacement was mixed however, with newer techniques and implants, many people find this an effective way to improve pain and function.

Living with shoulder joint arthritis

Managing shoulder arthritis involves a combination of treatments and lifestyle adjustments. Staying active, eating a healthy diet, and protecting your joints can also make a significant difference.

See below for a patient information leaflet from Versus Arthritis.

Patient information leafletDownload

Summary

Remember, while shoulder arthritis can be challenging, many people live full, active lives with the right approach to treatment and self-care. If you have any concerns about your shoulder pain or mobility, don’t hesitate to contact us to arrange an appointment with Dr Collins.

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What does private healthcare cost?

These days more people are choosing to pay for private healthcare, either because of long NHS waiting times or because they value direct access to a specialist. However, this often raises concerns around private treatment costs.

The first thing to highlight is that healthcare has always been a premium service, we are just shielded from this in the UK thanks to the incredible wonder that is the NHS. The investment of time and money in professional training and regulation required to ensure safe and effective care, along with the cost of medical technology, means that modern healthcare will always cost more than many other services we are used to paying for. This does not, however, always justify the very high prices that some clinicians charge, or guarantee that you will receive the most evidence-based care, so it is essential to ‘shop around’ to compare prices and do some research to consider the quality of private care you will receive.

Secondly, when calculating the total cost of private healthcare, it is important to remember that you may require further diagnostic tests, a course of treatment, or follow-up assessments. This is called a ‘pathway of care’ and you should feel free to ask what this may involve before parting with any money.

In my own practice a pathway of care typically involves an initial assessment (with diagnostic ultrasound performed at the time of assessment for no extra cost) which may be followed by a recommendation for further tests (such as MRI) to confirm the diagnosis. The cost of any additional tests are in addition to my fees and I will recommend the most cost effective options for these during the consultation. Once the diagnosis is clearly established I will provide advice on ongoing management (either by a letter following the additional tests, or by face to face follow-up if we agree this would be most useful). This advice may include a referral to a physiotherapist or other specialist and/or a recommendation for an ultrasound guided injection. The fees for injection treatments are additional to the consultation fees.

To find out more about the breakdown of these pathways of care please click here.

Finally, although each condition is unique, most musculoskeletal conditions not requiring surgical treatment can be managed in the private sector for between £200-£1000 (subject to the overall pathway of care) so you should aim to budget for this. If your total pathway of care will be substantially above this then consider whether you are being offered both the best quality of care and the best value for your money.

Please feel free to contact us to discuss the types of care I provide and what costs may be associated with this.

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Five facts on Frozen Shoulder

1 – The symptoms

From nowhere, and for no apparent reason, you start to notice an ache in the upper arm.  Gradually the pain worsens causing sudden, more severe spasms when you move the arm or bang it against something.  Soon you can’t sleep on that side and are getting interrupted nights along with finding it harder and harder to get dressed.

2 – Why does it happen?

Frozen Shoulder, also called Adhesive Capsulitis, is a condition which will affect around 5% of us, mainly during middle age.  For such a common condition we don’t exactly know what causes it.  It’s more common in women and people who are diabetic can get a more severe form of the condition but otherwise there may be no obvious reason for why we get it.

3 – What can I do for the pain?

Once started, the lining of the joint becomes inflamed causing pain at rest or on moving the joint.  At this point the most important treatment is to settle the inflammation.  In mild cases this can be through the use of over-the-counter anti-inflammatory medication but in most cases the best treatment is a steroid injection into the joint.  If administered early then symptoms can settle quickly and return you to normal function.

4 – What can I do for the stiffness?

If the inflammation stage is ignored and left untreated then the joint lining becomes thickened making the shoulder stiff and, instead of pain, you may find it hard to do daily activities.  This stiffness can last up to 12 months (with some studies showing it can go on for even longer than that) so, if things are very disabling, further treatment is recommended.  This can be keyhole surgery called capsular release which frees up the joint lining or an injection treatment called hydrodistension which uses a large volume of fluid to loosen the stiffened joint.

5 – What if I do nothing?

If left completely untreated, Frozen Shoulder gradually settles down by itself and typically doesn’t recur on the same side, however once you’ve had it you have an increased chance of getting it on the other side, so being aware of this and seeking early treatment if you notice the tell-tale symptoms will get you back to your old self more quickly.

For more detailed information on Frozen Shoulder click here and to contact us to find out what treatments I offer feel free to call or email us.

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3 Steps to Foot Fitness!

Whether you’re a runner, walker or dancer you probably take your feet for granted.  That is until they start to hurt.  Perhaps it’s because of a painful plantar fasciitis or maybe it’s down to a miserable Morton’s neuroma, there are many things that can grind us to a halt.  As a doctor working with British Olympic athletes, I treat feet that have been put through a lot.  However, the principles that guide us are just as relevant to recreational exercisers.  So here are my three steps to happy feet!

Step one: It’s okay to be different

Our feet are miracles of engineering, designed to take up to 3 times our body weight when running.  They are able to adapt to all types of surface and provide a perfect blend of suspension, stability and flexibility.  Researchers, recognising how adaptable our feet are, have started to challenge traditional ideas around what constitutes an ‘ideal’ foot shape. We’re all different and, on the whole, that’s absolutely fine.  Unfortunately, we’re assailed by an insole industry promising to ‘correct’ our abnormalities.  Often, they seek to solve problems that don’t exist, so don’t be seduced by unnecessary insoles; accept the feet you have and help them adapt to what you need them to do. 

Step two:  Steady as she goes

Not only are feet mechanical marvels, they can adapt with the forces we expose them to.  Remember the last time you were a bit more active than usual?  Remember how you felt the following day?  Well that soreness was the body letting you know it had been overloaded.  Fortunately, with some rest and a gradual return to the activity, the tissues get stronger and we stop feeling sore.  This is exactly the same for our feet.  Maybe it was a slightly overzealous ‘couch to 5K’ routine, or a sudden lifestyle change requiring more walking. Anything that causes a sudden foot overload can cause injury and, if we ignore the early warnings, the problem only gets worse.  Prevention is better than cure so, if you’re going to be on your feet a lot, remember to start off slow and increase gently.

Step three: Foot first aid

Maybe you’ve not followed the above steps and are now suffering with pain from an injury which won’t go away.  What can be done?  Well, injured tissues take time to heal and the more injured they are the longer they take.  It’s vital to reduce foot load for a sustained period of around 4 – 6 weeks.  This can be very hard for people used to being active but there are no short cuts to healing!  In severe cases we sometimes use protective boots and crutches to completely offload, but usually a switch to cushioned shoes, some self-discipline and time should be enough to reverse the situation.  If not, it may be time to check in with your friendly Sport Doctor!

So, there you have it, three steps to foot fitness and keeping active!