There is no such thing as the correct shoulder arthritis treatment. Once the diagnosis is known, the proper care for any given patient is not necessarily a medical decision but rather a personal choice. The best treatment shouldn’t be doctor “directed” but rather patient “requested”. Like other forms of degenerative arthritis, shoulder arthritis treatment options consist of ignoring the problem, “curing” the problem and treating the symptoms. What is right for you depends on your symptoms, how much they are affecting your quality of life, what your goals are and what you are willing to try. Your doctor and your imaging studies can define what the problem is but not what the solution should be. That will be your job.
Let’s look at your shoulder arthritis treatment options…
Shoulder Arthritis Treatment Options
There are two main reasons that we treat any medical problem: to prevent the problem from worsening or to improve the symptoms. We cannot reverse shoulder arthritis. Nor can we stop its progression. So the only reason to treat shoulder arthritis is that you are having bothersome symptoms. Consequently, if your symptoms are mild and acceptable to you, then the appropriate shoulder arthritis treatment for you may be just to ignore your arthritis.
A shoulder replacement is the only way to ensure that your shoulder arthritis goes away for good. In this procedure, both the end of your humerus and the surface of your glenoid or, in some cases, just the end of the humerus, are replaced with metal and plastic. Since these materials don’t have nerves in them, when they move against one another, there is no pain. We’ll talk more about shoulder replacements in a future post.
2. Treat the symptoms
For many, this is where the treatment starts. The expectation with this approach shouldn’t be to end the problem, but rather to manage it. Sometimes this can work great. Other times, not so well. Unfortunately, treating the symptoms is unpredictable. There is no reliable way to tell what will work, how much it will work or how long it will work. Usually, no specifics about your symptoms or findings on your exam or imaging studies can help us answer those questions.
There are three types of treatments: Nonoperative noninvasive, Nonoperative invasive and operative (other than a joint replacement).
The options for this type of treatment are anti-inflammatory medications, physical therapy, pain medications, changing your activities to a level that is less painful and alternative treatments. I find that for shoulder arthritis, typically the most helpful of these options is altering your activities and using oral anti-inflammatories. Physical therapy doesn’t reliably help reduce symptoms of shoulder arthritis. In fact, I find that it often can aggravate the symptoms by stressing your shoulder beyond its limits.
These are injections. There are three types: Cortisone, Viscosupplementation, and Platelet Rich Plasma (PRP) with or without stem cells. There is not a tremendous amount of data at this time that supports the efficacy of these treatments in shoulder arthritis. Similarly, no reliable research that can recommend one type of injection over another.
Cortisone injections are a mixture of an injectable steroid and Lidocaine. Lidocaine is familiar to many of us as the numbing medication often used by our dentist. The goal of this type of injection is to harness the substantial anti-inflammatory effect of steroids to reduce inflammation in your shoulder joint.
Viscosupplementation is an injectable gel-like material that is manufactured to mimic the natural lubricant found in a healthy joint. It is only FDA authorized for use in the knee. Although many of us have used this same medication in the shoulder, unfortunately, because of a lack of FDA authorization, your insurance company may not pay for this medication. It is unclear how this works…or even if it works for shoulder arthritis at all.
PRP with or without stem cells is a newer treatment. It uses cells found in your blood in the case of PRP, and in your blood or other tissues in the case of stem cells. The goal is to modify the status of your shoulder rather than merely to reduce your symptoms. The experience with these substances is still in the early stages. So there is very little if any data that confirms a beneficial effect of these materials for shoulder arthritis treatment.
Operative treatment options, other than a shoulder replacement, consist of shoulder arthroscopy with or without subchondroplasty. Although there is scant evidence that these procedures can reliably reduce the symptoms of arthritis, there is anecdotal information that suggests that in some cases they can.
Arthroscopy is a minimally invasive surgical procedure. It can be used to “clean out” the arthritic shoulder joint. It can remove loose fragments of cartilage and bone, diminish inflamed tissue and smooth frayed tendons. So if any of these are responsible for your symptoms, then arthroscopy may help. If your symptoms are solely due to the exposed bone from the loss of the overlying cartilage, arthroscopy is unlikely to be beneficial.
Subchondroplasty is another minimally invasive technique. It utilizes a small incision to inject a natural bone “cement” to fill bone injuries (bone marrow lesions) occasionally associated with arthritis. Subchondroplasty is usually performed along with arthroscopy. Although most frequently used in the knee, it can also be used in the shoulder in select cases.
Shoulder arthritis treatment can often successfully reduce or eliminate your symptoms. What treatment is best for you is dependant on many personal and some medical variables. If you are suffering from shoulder arthritis and you are looking for relief, see your shoulder surgeon and get an evaluation and assistance in getting on the road to a healthier shoulder.
What if in addition to arthritis, there are tears in the rotator cuff?
Is this my Phyllis Sloan? If so you are a member of the “Direct Access Plan” :) Just call me direct. In short, it depends on how big the RC tears are. Often there are very “small” or “tiny partial thickness” tears described on the MRI. These are of no clinical significance and do not change the treatment plan. If however, the tear is of moderate-sized, it may be able to be fixed at the time of the shoulder replacement. If a “massive -irreparable” tear, the person may require a specific type of replacement – a Reverse total shoulder replacement and the RC tear would not need to be addressed.