Shoulder arthritis causes pain and stiffness. It occurs in people older than 50 and is more common after an injury. Shoulder joint injections can help. But does an intra-articular shoulder injection, such as cortisone, hyaluronic acid, or PRP, help with the pain?
What is the Shoulder Joint?
The shoulder joint is a ball-and-socket joint that connects the upper arm to 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 Shoulder Arthritis do you Have?
Osteoarthritis is the most common form of arthritis affecting the shoulder. We often refer to this arthritis as wear and tear. As the protective cartilage is worn away, the bare bone is exposed. Usually, a history of trauma, such as a fracture or dislocation, can increase the risk of arthritis. Also, there is a genetic tendency to develop this type of arthritis.
Inflammatory arthritis is another common cause. This autoimmune disease causes inflammation of the joint’s lining. This inflammation destroys cartilage, leading to arthritis.
Symptoms of Shoulder Arthritis
The pain of arthritis often worsens as the disease progresses. Symptoms of shoulder arthritis include shoulder pain, weakness in shoulder movements, stiffness and restriction, joint swelling, and a catching or grinding sensation.
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 a frozen shoulder?
Both conditions cause pain and movement restriction. Both are treated with a shoulder joint injection. So, how do you distinguish between them? Firstly, shoulder arthritis typically affects individuals aged 60 and older. On the other hand, frozen shoulder affects individuals aged 4- 60. Secondly, an X-ray of the shoulder joint is normal in a case of frozen shoulder. Finally, the symptoms of a frozen shoulder develop over several weeks to a few months, whereas shoulder arthritis symptoms worsen over many months.
How do we treat shoulder arthritis?
In general, simple treatments are used first. Options include:
- Activity modification: We often limit our activities, including sports. Contact sports and sports that involve full shoulder movement, such as tennis, are often associated with shoulder pain in arthritis.
- Physiotherapy: Strengthening the muscles around the shoulder and scapulae can reduce joint load, thereby improving symptoms.
- Anti-inflammatory medications: Tablets such as ibuprofen help reduce inflammation and relieve pain. However, be cautious of potential side effects, such as stomach ulcers.
- Intra-articular shoulder joint injection: Joint injections in the shoulder joint provide pain relief and can aid exercise recovery.
- Surgery: In severe cases, a surgical replacement may be necessary. In this procedure, surgeons remove cartilage and replace it with a metal-and-plastic ball-and-socket implant in the shoulder.
More about intra-articular shoulder injection
Typically, we administer shoulder joint injections to alleviate pain and improve function. Injections are performed with or without imaging guidance. Overall, imaging-guided injections, such as ultrasound or X-ray, are more accurate. Moreover, ultrasound is significantly less expensive than X-ray and is often preferred by patients.
Options for shoulder joint injection include corticosteroids, hyaluronic acid, and platelet-rich plasma (PRP).
Cortisone is the most common injection and provides short-term relief from pain. Generally, we use cortisone as the first-line injectable treatment, especially for severe pain and movement restriction.
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 for at least six months.
PRP injections for shoulder arthritis
We obtain PRP (platelet-rich plasma) from whole blood. Next, we centrifuge the blood to separate the plasma from the cells. Finally, the plasma is injected into the shoulder joint. While PRP improves pain in knee arthritis, there is little evidence for its use in shoulder arthritis.
Given the evidence for shoulder joint injections, we recommend a simple cortisone injection as a first step. 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 the suprascapular nerve, a nerve in the shoulder, are effective in reducing pain for approximately 12 weeks. However, it is essential to do this injection with ultrasound to improve accuracy and prevent rare side effects such as a puncture of the lung. Generally, we combine a suprascapular nerve block with other shoulder joint injection treatments, such as hyaluronic acid or cortisone, into the shoulder joint.
Other commonly asked questions about shoulder joint injections:
What is the preferred injection option for shoulder osteoarthritis?
Overall, when considering the pros and cons of injection options, we believe Durolane is likely the preferred choice. Durolane is a cross-linked, high-molecular-weight hyaluronic acid. Cross-linking means it remains in the joint longer than other hyaluronic acids. Its high molecular weight indicates a more potent effect.
However, Duroalne must be injected with ultrasound guidance to improve accuracy and reduce potential side effects such as joint flare.
Does a cortisone injection in the shoulder eliminate arthritis?
While cortisone effectively improves pain and function in shoulder arthritis, it does not regenerate cartilage or eliminate arthritis. Moreover, there is evidence that cortisone may accelerate the progression of arthritis.
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