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There are, not one, but two joints in
the shoulder. The first is located where the collar bone meets the
tip of the shoulder bone. This is called the acromioclavicular or AC
joint. The junction of the upper arm bone (humerus) with the shoulder
blade (scapula) is called the glenohumeral joint. Both joints may be
affected by arthritis. The condition, however, is more common in the
AC joint than in the glenohumeral joint.
Osteoarthritis does not affect the
shoulder joint as much as it does the larger weight bearing joints of
the body. It usually follows on from an injury to the shoulder or
surgery to that area. Following shoulder trauma damaged ligaments may
go undetected. This may lead, over time, to the development of bone
spurs as the body tries to reduce joint motion.
Pain in the shoulder is the most common
symptom of osteoarthritis of the shoulder. If the glenohumeral
shoulder joint is affected, the pain is centered in the back of the
shoulder and may intensify with changes in the weather. The pain of
arthritis in the AC joint is focused on the front of the shoulder.
The pain may be accompanied by limited motion. In advanced stages,
the pain will be ongoing, making sleep difficult, The pain will also
be triggered by even the slightest shoulder movement.
Initial treatment of osteoarthritis of
the shoulder is geared towards pain management. The first step
involves health and behavior modifications. Patient education,
physical therapy, and exercise form the mainstays of these
modifications. Bracing may also be applied to the affected area.
Drug therapies range from basic pain
relief medications, such as aspirin and non-steroidal
anti-inflammatories to Cox-2 specific inhibitors, opiates and
stronger drugs.
Corticosteroid
injections or injections of hyaluronic acid may also be given.
Surgery, including arthroscopy, osteotomy and arthroplasty (joint
replacement) will be considered as a last resort. Arthritis of the
glenohumeral joint can be treated by replacing the entire shoulder
joint with a prosthesis (total shoulder arthroplasty) or by replacing
the head of the upper arm bone (hemiarthroplasty). The most common
surgical procedure used to treat arthritis of the AC joint is a
resection arthroplasty. In this procedure, a small piece of bone from
the end of the collarbone is removed, leaving a space that later
fills with scar tissue. Surgical treatment of arthritis of the
shoulder is generally very effective in reducing pain and restoring
motion.
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