Shoulder arthritis causes pain and stiffness. It occurs in people older than 50 years, and it is more common after an injury. Injections into shoulder joint such as cortisone, hyaluronic acid, or PRP can help with the pain.
What is the shoulder joint?
The shoulder joint is a ball and socket joint connecting the upper arm with the shoulder blade. The joint has more movement than any other joint in the body. The cartilage and ligaments of the shoulder provide much more stability.
What type of arthritis do you have?
Osteoarthritis is the most common form of shoulder arthritis. We often refer to this arthritis as ‘wear and tear’. As the protective cartilage is worn away, the bare bone is exposed. Often, a history of trauma such as a fracture or dislocation can increase the risk of arthritis. Also, there is a genetic tendency to developing this type of arthritis.
Inflammatory arthritis is another common cause. This autoimmune disease leads to inflammation of the lining of the joint. This inflammation invades and destroys the cartilage leading to arthritis.
Symptoms of arthritis
The pain of arthritis often worsens as arthritis deteriorates. Symptoms of shoulder arthritis include pain in the shoulder, weakness of shoulder movements, stiffness and restriction, swelling of the joint, and catching or grinding.
Generally, a physical examination and a plain X-ray are needed to confirm a diagnosis of shoulder arthritis.
What is the difference between shoulder arthritis and frozen shoulder?
Both conditions cause pain and restriction in movement. So, how do you tell the difference?
Firstly, shoulder arthritis usually affects older people above the age of 50. On the other hand, frozen shoulder often affects people between the ages of 40-60 years. Secondly, an X-ray of the shoulder joint is normal in frozen shoulder.
How do we treat shoulder arthritis?
In general, simple treatments are used first. Options include:
- Activity modification: We often limit our activities including sport. Contact sport or sport involving full movement of the shoulder such as tennis is often difficult with shoulder arthritis.
- Physiotherapy: Strengthening of the muscles around the shoulder and shoulder blade can reduce the loads on the joint improving symptoms.
- Anti-inflammatory medications: Tablets such as ibuprofen reduces inflammation and can help pain. However, you need to be careful with side effects such as stomach ulcers.
- Injections in shoulder joint: We know that injections in the shoulder joint provide pain relief and can help with exercise.
- Surgery: In severe cases, a surgical replacement will help. In this procedure, doctors remove cartilage and place a metal and plastic ball and socket implant in the shoulder.
More about injections in shoulder joint
Usually, we perform injections in shoulder joint to improve pain and function. Injections are performed with or without imaging guidance such as ultrasound or X-ray. Overall, injections with imaging are more accurate. Also, using ultrasound is much cheaper than X-ray and often preferred by patients.
Options for injections into the shoulder joint include cortisone, hyaluronic acid, or PRP.
Cortisone is the most common injection and provides short-term relief from pain. Some doctors use hyaluronic acid, a naturally occurring substance in bones and joints. A recent study found that injection of hyaluronic acid into the shoulder joint reduces pain after 6 months. We obtain PRP or platelet-rich plasma from whole blood. We spin the blood and extract the plasma from the cells. Finally, the plasma is then injected into the shoulder joint. While PRP improves pain with knee arthritis, there is little evidence for use in shoulder arthritis.
Overall, taking into consideration all the evidence, we suggest a simple cortisone injection first. Then, if the pain returns, we recommend a hyaluronic acid injection such as durolane.
Nerve block injections for shoulder arthritis
In some cases of shoulder arthritis, injections targeting a nerve in the shoulder called the suprascapular nerve are effective at reducing pain for about 12 weeks. It is important to do this injection with ultrasound to improve accuracy and prevent rare side effects such as a punctured lung. Generally, we combine a suprascapular nerve block with other injection treatments such as hyaluronic acid or cortisone into the shoulder joint.
Other common shoulder conditions: