Degenerative diseases are the most common joint diseases in India, which are widespread in 22-39% of the population. This problem is more common in women as compared to men. 45% of women over the age of 65 in India have symptoms of degenerative diseases or any form of arthritis. 70% of those over 65 years show radiological evidence of degenerative shoulder diseases.

Pain and stiffness caused by shoulder arthritis can affect the arm movement. It can be painful and difficult to lift a plate from the cupboard, or even brush your teeth. Even moderate shoulder arthritis can cause chronic dull pain or repeated attacks of severe pain that disturbs sleep.

Degenerative diseases: It means a continuous degenerative process occurring in the cells, thus deteriorating tissues and organs. It affects the whole body and bones too. A diseased shoulder causes pain and stiffness. These symptoms can have a significant impact on the mobility of people with the affected joint.

Although there is no cure for arthritis in the shoulder, there are many treatment options available so most arthritis sufferers can get pain relief and remain active.

In this article, Dr.B. Chandrashekar discusses the cause of degenerative disease of the shoulder joint and help people how to deal with pain.

How Shoulder Degenerative Disease Causes Pain:

The joint may undergo many changes during the arthritis process and causes pain. These changes include:

• Damaged cartilage
• Bone spurs and other excess bone growth
• Bone lesions
• Inflammation
• Changes to other soft tissues

Causes And Types of Degenerative Diseases In shoulder Joint:

There are several forms of shoulder joint inflammation. Everyone may have a different reason, and some causes of shoulder arthritis are unknown. The below five main types of arthritis usually affect the shoulder.

Osteoarthritis In Shoulder:

Osteoarthritis is also known as degenerative joint disease. It is often associated with age-related wear and tear. It can also affect joints other than the shoulder and is the most common form of arthritis.

Rheumatoid Arthritis In Shoulder:

Rheumatoid arthritis is an autoimmune disease in which your body attacks own healthy cells, which may include the synovial membrane. This inflammatory arthritis can be present on both shoulders at the same time.

Post-Traumatic Shoulder Arthritis:

If your shoulder gets broken, slipped, or injured, you may experience post-traumatic arthritis.

Rotator Cuff Tear:

Rotator cuff arthropathy is a type of shoulder arthritis that can develop after a massive and prolonged rupture of the rotator cuff. The four rotator cuff tendons on a shoulder encircle the ball of the shoulder joint and hold it in place. If one or more of these tendons tear badly, this can cause the shoulder to rub against other bones and develop arthritis.

Avascular Necrosis in Shoulder:

Avascular necrosis is understood as limited blood supply to parts of the body, which causes the death of the particular area (necrosis). In the shoulder, the humeral head (shoulder ball) can lose its blood supply due to illness, traumatic injury, and other
causes. Without a blood supply, bones slowly collapse, become uneven and cause arthritis.

Diagnosis of Degenerative Disease in Shoulder:

After discussing your symptoms and medical history, a doctor will examine your shoulder. During the physical examination, a doctor will observe:

• Weakness (atrophy) in the muscles
• Tenderness to touch
• The passive and active range of shoulder motion
• Any signs of injury to the surrounding joints
• Signs of any previous damage
• Crepitus
• Pain when pressure applied to the joint

After a physical examination, the doctor may order you to take an x-ray. If you experience degenerative diseases, they show a narrowing of joint space, bone changes and bone spore formation (osteophytes) in X-ray report.

Treatments for Shoulder Degenerative Diseases:

Although arthritis is a chronic disease, treatments can help manage your symptoms and keep you active.

Non-Pharmacologic Treatments

If you have to shoulder degenerative disease, start with the basics of self-care to manage your symptoms. As with any joint, the initial treatment for shoulder arthritis is usually not through surgery. Non-pharmacologic treatment includes:

• Changes In Activity: Avoid activities that make the arm weigh heavily, reduce the heavy burden carried by the affected arm, and try to change their sporting activities that might reduce tension on the affected arm.
• Moist Heat: Heating can make arms feel better.
• Icing: Icing the shoulders three or four times a day can help reduce inflammation, especially after exercising or stress on the shoulder
• Lifestyle Modification: The second medical treatment is to avoid things that cause shoulder pain. In general, whatever causes pain must get avoided, primarily if the pain is affecting your life activity. If your shoulder pain lasts several days, and you wake up at night, it might be wise to question how important this activity is to you.
• Physiotherapy: This may play a role in maintaining or increasing range of motion and strength, but in certain circumstances, it can worsen osteoarthritis. Therefore, their role must review if it is a source of worsening pain.
• By stretching and strengthening the muscles that support the shoulder joint, shoulder pain and stiffness can reduce, and the range of motion increases. The physiotherapist can create a suitable exercise program, teach it to the patient, and monitor the patient until he can switch to an independent program at home.

Pharmacologic Treatments:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin are useful drugs that are prescribed by a doctor and must be taken with prescription. These medicines should be taken after food as they can irritate the stomach. Anti-inflammatory medications are prescribed, which may be more comfortable in require doses, have fewer side effects and tolerated better.
• Food Supplements: While some patients find relief in it, there is little scientific evidence for the role or value of food supplements in the treatment of arthritis. It is recommended to consult a doctor before taking any dietary supplements.

Injections:

• Corticosteroid injections (cortisone): It can help in the treatment of inflammation in the joints. Although cortisone injection is often associated with low risk, patients with diabetes can experience an increase in blood sugar during a variable period after a cortisone injection.
• Viscose supplementation injections: These synthetic compounds, such as hyaluronic acid and their derivatives, have a structure similar to normal synovial fluid. They are injected into the joint to increase joint lubrication.

Surgical Treatment:

You and your doctor can consider surgery if your pain and mobility do not improve with physical therapy and medication.

If non-surgical treatments are not productive, a doctor can discuss the following surgical options:

• Arthroscopy:

This is a minimally invasive surgery that requires anaesthesia, where a small camera inserted through a small incision in the joint. Another incision allows a small instrument to be inserted into the joint to manipulate tissue.

Shoulder arthroscopy is performed to remove loose cartilage and bone fragments in the joints (destruction) may be involved in early arthritis if the articular surface is only slightly damaged. It does not eliminate arthritis but can help in removing irritating tissue pieces. The benefits may be minimal when subjecting patients to surgery and anaesthesia, which has no role in effectively treating the symptoms of advanced arthritis.

• Shoulder Replacement: This is a surgery similar to the concept of hip or knee replacement, where plastic and metal implants are implanted to create a new joint surface. During this operation, which requires a large incision, as with all open surgeries, the humeral ball is removed and replaced with a metal ball (prosthesis) attached to a metal stem that runs on the upper bone.A fine plastic socket covers the arthritic socket, also called a prosthesis. It is a smooth metal ball that moves along a smooth plastic socket and reduces pain. The most common shoulder replacement surgeries include:
  • Complete replacement of shoulder Joint: Both arthritis ball and socket create a new surface. Like a natural shoulder, the prosthetic ball is located in a plastic socket and relies on the patient’s muscles and tendons for movement and stability.
  • Hemiarthroplasty: In this procedure, the only ball joint is replaced, not a socket joint. It is most beneficial in cases where articular cartilage is healthy or has minimal damage and is used far less often than complete shoulder replacement.
  • Reverse shoulder Replacement: A metal ball placed in the patient’s socket, and a plastic cup is placed on the upper bone. This procedure is used when the patient’s soft tissue itself is not healthy enough to move or stabilize joint replacement. It is most often used in treating types of arthritis where both rotator cuffs are badly damaged and if arthritis is greatly affected.

Rehabilitation:

Since the shoulder has the most excellent range of motion of all joints in the body, recovery from injury, injury or surgery is often assisted by rehabilitation and physical therapy, or to increase or maintain movement, or to increase strength.

Conclusion:

In the early stages of the disease, symptoms are usually mild and do not significantly affect a range of motion. If arthritis is more severe, severe pain and loss of movement can occur in the injured shoulder joint.

Regular exercise keeps the shoulder joint active, which can have a noticeable effect on reducing pain and increasing freedom of movement in this area of the body.

People must be careful to avoid further damage to their joints or the surrounding tissue. Although shoulder arthritis is less common arthritis, it can be equally debilitating and significantly affect the quality of life. Fortunately, depending on the severity and extent of the injury, there are effective non-surgical and surgical treatments that make this disease compatible with a productive, healthy and active life.

If you’re the patient suffering from degenerative shoulder diseases, Contact Dr.B. Chandrashekar, Shoulder Surgeon for the best treatment option.