Shoulder Arthritis

Acromioclavicular Arthritis

Pt with h/o trauma presents with anterior/superior shoulder pain. Acromioclavicular joint tenderness, painful cross-body adduction test on exam.

Shoulder joint, posterior view. By Jmarchn - Own work.

Shoulder joint, posterior view. By Jmarchn - Own work.

  • Obtain shoulder x-ray

  • Start Tylenol/NSAIDs, heat, and stretching for pain

  • Consider intra-articular corticosteroid injection vs. surgery if symptoms do not improve

Glenohumeral Osteoarthritis

Patient age > 50 years with h/o autoimmune disease/arthritis, shoulder injury, and previous shoulder surgery presents with progressive, diffuse shoulder pain in deltoid region. Reports gradual onset of shoulder stiffness and loss of motion due to pain with activity. Sometimes experiences pain at night on the affected side. Joint line tenderness under the coracoid process, crepitus with active/passive range of motion, restricted external rotation, weakness with overhead arm raise, and a positive Apley scratch test on exam.

  • Obtain shoulder x-ray and evaluate for joint space narrowing, spurring/osteophytes

  • Conservative therapy

    • Start Tylenol/NSAIDs, heat, and stretching for pain

    • Refer for 6 week course of physical therapy

    • Patient advised to avoid overhead activity

    • Follow up in 6 weeks

  • Additional treatment

    • No improvement after 6 weeks: Inject glenohumeral joint with mixture of

      • 1 mL triamcinolone acetonide 40 mg/mL

      • 2 mL 1% lidocaine without epinephrine

    • No improvement at 3 months

      • Consider repeating radiographs to evaluate for disease progression

      • Schedule repeat joint injection 3 months after initial injection

    • Refer to orthopedics for persistent pain affecting quality of life and no improvement after 3 months of conservative therapy and 2 shoulder injections at least 3 months apart; patient counseled that treatment options may include

      • Osteophyte debridement in patients younger than 50 years

      • Prosthetic joint replacement

    • Patient counseled that the results of shoulder surgery are variable and that symptoms generally recur to some degree within 10 years of the procedure

Notes

  • Overall, glenohumeral osteoarthritis an uncommon cause of shoulder pain

  • Generally preceded by remote history of shoulder injury