A: Has throwing the ball with the kids become a big pain in the shoulder? As we get older our joints may deteriorate, with loss of the smooth cartilage coating of the bones in the shoulder joint, a process known as arthritis. It can be caused by a variety of factors, but the most common process in the shoulder is degenerative joint disease (DJD). The shoulder is made up of two distinct joints, the large ball-and-socket Gleno-Humeral Joint (GH), where the arm meets socket of the shoulder blade, and the much smaller Acromio-Clavicular (AC) Joint, where the top part of the shoulder blade (the acromion) meets the collar bone (clavicle). Either or both joints can become damaged and painful, and X-rays will be used to detect whether arthritis is present.



Once the diagnosis is made, treatment generally starts with oral medications to reduce the pain and inflammation within the joints. This generally starts with medicines like Tylenol or anti-inflammatories known as NSAIDs, either over-the-counter or by prescription. Sometimes it is necessary to use a short course of stronger anti-inflammatory medicines known as steroids, such as prednisone, usually given in a precise regimen that is tapered quickly. Some patients will benefit from Physical Therapy treatments, which can help by improving the range of motion and strength in the shoulder.

If this approach is not successful, a patient may need to have a steroid injection in the shoulder, which can be effective by placing the anti-inflammatory material directly into the painful area. The effect may not last long, but the injection can help to confirm that the arthritic area is actually causing the shoulder pain. On the other hand, some shots will lead to long-term pain relief. We have some patients who come to the office every six months for a steroid shot and function well between visits.

If this approach is not working, surgery may be needed. An MRI is often obtained to rule out other shoulder damage, such as tendonitis or a rotator cuff tear, and it is also useful to gauge the full extent of the arthritis.

If the upper (AC) joint is the primary source of pain, and conservative measures have failed, relatively simple surgery can usually solve the problem. The AC joint pain seems to come from the deformed ends of the bones which rub together once the cartilage coating has worn away. We can remove the ends of the bones and the scar that fills the space will gradually become comfortable. At first, this was done as an open procedure, but now it is done routinely through small stab wounds using a fiber-optic tool known as an arthroscope.

When the ball-and-socket shoulder joint (GH) is arthritic and requires surgery, things get more complicated. As an open procedure, requiring an incision that is about six inches long, the damaged joint surfaces can be replaced by an artificial joint made of plastic and metal. This procedure has evolved over the years and is now very reliable. The recovery period will last six to twelve months and will require Physical Therapy. When a patient has fully recovered, the shoulder strength and function should be reasonably good, but patients almost always report that their pain is gone. In fact, some of our happiest patients are those who put up with severe shoulder arthritis for years and after getting a Total Shoulder Replacement could finally get a good night's sleep.

We have a dilemma when a patient has severe ball-and-socket shoulder arthritis along with a large rotator cuff tear. The soft tissue envelope of tendons around the shoulder is known as the Rotator Cuff, and if it is massively torn and unrepairable, a conventional shoulder replacement may not work well, because the shoulder will be weak and unstable and the components will tend to become loose and painful. Fortunately, an ingenious solution has been developed to deal with this situation. A Reverse Total Shoulder Arthroplasty is a plastic and metal device which replaces the socket with a ball and replaces the ball with a socket, allowing most patients to regain overhead motion without an intact rotator cuff. The surgery is somewhat more complicated and there are more potential complications, but for certain patients, it is just what the doctor ordered.

What to do: If you have shoulder pain that lasts more than a few weeks, try gentle stretching and over-the-counter medicines such as Tylenol or NSAIDs. If you cannot get relief, make plans to see your doctor. These days, most shoulder pain can be resolved. With any luck you will be able to get back to throwing in the backyard in time for spring training.