Pain Relief for Shoulder Arthritis and Tendon Inflammation

If you experience shoulder pain, you know how it can put a damper on life. It can make even simple activities—such as washing your hair or scratching your back—difficult or even impossible.

In a Boulder Community Health online health lecture, orthopedic surgeon Meredith Mayo, MD, of Boulder Centre for Orthopedics & Spine described some of the common causes of shoulder pain—osteoarthritis and tendon inflammation—as well as some general treatment options.

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VIDEO: Watch "Relieving Shoulder Pain"

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Symptoms of Wear-and-Tear Shoulder Arthritis

Osteoarthritis, or wear-and-tear arthritis, results when there is damage to the cartilage in our joints. Cartilage in the shoulder covers both the ball (the humeral head) and the socket (the glenoid). Wear-and-tear shoulder arthritis occurs when the cartilage in our shoulders begins to break down.

“People with arthritis, or joint wear and tear,” said Dr. Mayo, “will have a slow loss of range of motion. Some may not have any pain, but they can’t move their arm. They hear a popping noise and feel a grinding sensation. They will have deep aches and consistent pain at night.”

Those who will experience symptoms include:

• Athletes who throw for their sport.
• Manual laborers who are consistently lifting in non-anatomic positions.
• Rheumatologic diseases that attack the cartilage in our shoulder.
• Prior shoulder dislocation (may have occurred many years prior).
• Prior broken arm bone (humerus).

Initial Conservative Treatment of Arthritis

• Steroid injections. Wear-and-tear arthritis is an inflammatory process and steroids can reduce the pain and inflammation.
• Physical therapy for mild or moderate arthritis, if it’s not painful for the patient.
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can be helpful to reduce the pain.
• Platelet-rich plasma (PRP) injections. “This is where we take your blood, spin it to separate the cell types and reinject those cells that can stimulate healing,” said Dr. Mayo.

When is surgery necessary for wear-and-tear shoulder arthritis?

When non-surgical options have failed to provide pain relief and there’s progressive or severe loss of motion of the shoulder joint, that’s when surgery may become necessary.

Comprehensive Arthroscopic Management

Dr. Mayo said, “To maintain your native shoulder joint and enjoy a quick recovery, comprehensive arthroscopic management is a simple option that is ideal

• for mild to moderate shoulder arthritis,
• to remove bone spurs and loose bone fragments,
• stimulate bone marrow and/or
• release soft tissue, surrounding joint for mobility.”

Total Shoulder Replacement

Total shoulder replacement involves replacing your ball and socket with a metal ball and plastic socket. "This is a same-day or inpatient surgery for which you will wear a sling with a pillow for six weeks. Physical therapy is prescribed for 12 weeks, and near full recovery is expected within four to six months," noted Dr. Mayo. “Improvement can continue for up to two years.”

Symptoms of Rotator Cuff Inflammation

The rotator cuff is the group of muscles and tendons that surround the shoulder joint. “It is,” said Dr. Mayo, “a ball-and-socket joint and the most mobile joint in our bodies.” It also controls arm rotation and elevation.

“Impingement, bursitis, and rotator cuff tendinosis all refer to similar inflammatory issues of the shoulder,” explained Dr. Mayo. In general, these terms describe the pain and swelling of the rotator cuff tendons that surround the bursa. The bursa is a soft sack that contains fluid that cushions the joint.

“With rotator cuff tendinosis,” said Dr. Mayo, “the tendon itself remains intact, but is very unhappy.” She added, “Impingement, which is a pinching, is the most common cause of shoulder pain. It occurs when the top of the shoulder blade puts pressure on the underlying soft tissues when the arm is lifted away from the body. As the arm is lifted, the shoulder blade rubs, or "impinges" on, the rotator cuff tendons and bursa. This can lead to bursitis and tendinosis, causing pain and limiting movement.”

Symptoms of rotator cuff inflammation include:

• Shoulder pain on the side and sometimes the front.
• Difficulty with overhead activities and reaching away or behind the body.
• Should not experience weakness as the rotator cuff is still attached.
• May occur as slow onset from overuse.
• Waxes and wanes: people have good and bad days.

Non-operative/Conservative Treatment for Tendon Inflammation

• Non-steroidal anti-inflammatory (NSAIDs) medicines such as ibuprofen.
• Physical therapy (PT) as a home program or formal sessions with a therapist that can include massage and/or stimulation.
• Activity modification may be recommended to reduce impact on the shoulder.
• Steroid injections are the last course of action. They’re reserved to get people through severe pain, allow them to sleep and get through their PT treatments.

Click here to view/download a PDF of slides shown during this lecture.

Please call 303-449-2730 to schedule an appointment with Meredith Mayo, MD.