Meredith Mayo, MD, on treating arthritic shoulders

If you have arthritis in your shoulders, you know how much it can put a damper on life. The pain, stiffness and loss of motion can make even simple activities — such as washing your hair — difficult or even impossible. Luckily, there are many treatment options.

Fellowship-trained sports medicine and orthopedic surgeon Meredith Mayo, MD, of BoulderCentre for Orthopedics described the latest non-surgical and surgical treatment options for shoulder arthritis sufferers during a recent free online health lecture.

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Watch "Latest Treatments for Arthritic Shoulders"

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What is shoulder arthritis?

“Shoulder arthritis is inflammation of the shoulder joint. This inflammation causes pain and stiffness and can make lifting your arm uncomfortable. Over time, arthritis leads to loss of the cartilage that covers your shoulder socket. Without cartilage, we no longer have a protective cushion, our bones begin to rub against each other, and they no longer glide easily,” said Dr. Mayo.

The most frequently occurring types of arthritis that affect the shoulder are the following:

• Primary osteoarthritis - caused by wear and tear over time. This wear causes cartilage loss, bones grinding against one another, and results in severe pain.
• Post-traumatic arthritis - develops over time and after you have dislocated your shoulder or broken an arm.
• Inflammatory arthritis - occurs with conditions such as rheumatoid arthritis, gout and autoimmune diseases associated with break downs in the immune system. Fortunately, there have been many medical advances, and the need for surgical treatment has diminished.
• Avascular necrosis - less common and occurs when there is a loss of blood flowing to the top of the humerus (the long bone that runs between the shoulder and elbow). Typically, this affects the ball joint. It can be caused by severe trauma, high doses of oral steroids, chemotherapy and occasionally from radiation therapy. “This” said Dr. Mayo, “is a slow process and the pain isn’t noticeable until the bone actually collapses.”
• Rotator cuff arthropathy - results in a specific wear pattern when the rotator cuff is damaged.

Symptoms of shoulder arthritis

• Pain - Pain in the shoulder joint is the major sign of arthritis. It can be present in the front, side or back of the shoulder.
• Limited range of motion - It may become more difficult to lift your arm to comb your hair or reach up to a shelf.
• Grinding, clicking or cracking (crepitus) - This may or may not be painful. Sometimes the shoulder may “lock up.”

NON-SURGICAL TREATMENT OPTIONS FOR MILD TO MODERATE SYMPTOMS

No treatment is an option

“We like to consider the least invasive options first. I tell patients if your function and pain level are satisfactory, we don’t have to do anything,” said Dr. Mayo.

Physical therapy (PT)

“PT can include stretching, exercises, electrical stimulation or dry needling,” Dr. Mayo explained. “The goals of physical therapy are to improve range of motion, decrease pain and/or dysfunction of the shoulder blade and neck muscles, and optimize strength.”

Medication management

Medication management is used to decrease inflammatory pain with the use of non-steroidal anti-inflammatory drugs (NSAIDS) such as Advil, Aleve or Motrin. “To improve sleep, a muscle relaxant is prescribed for bedtime use only,” Dr. Mayo stated.

Injections

“Injections,” said Dr. Mayo “are a bit more invasive. They can be effective for arthritis of all severities.” She described three options and noted that only corticosteroid is covered by insurance.

• Corticosteroid - an anti-inflammatory. It’s used to control pain.
• Hyaluronic Acid - a mechanical lubricant. This is only covered by insurance for arthritic knees, but Dr. Mayo has had very good success using this to treat arthritic shoulders. She describes it as being like WD-40, coating the joints to smooth them out.
• Platelet Rich Plasma (PRP) - a regenerative biologic. This is the only option that can improve the cartilage damage in the shoulder. "The procedure includes a blood draw, placing your blood in a centrifuge to separate the red blood cells and concentrate the plasma," Dr. Mayo notes. “Concentrated plasma has healing properties. The goal of PRP therapy is to attack and heal the rough, abnormal cartilage surfaces.”

SURGICAL OPTIONS FOR SHOULDER ARTHRITIS

If non-surgical options no longer provide relief, then your physician may suggest surgery.

Shoulder Joint Preservation

Dr. Mayo described two joint preservation procedures for shoulder arthritis:

• Comprehensive Arthroscopic Management (CAM) Procedure - a minimally invasive arthroscopic procedure that addresses mechanical and inflammatory pain produced by arthritis. It removes the inflammatory tissue, any bone or cartilage pieces that may be floating around the joint and occasionally bone spurs.
  
  Dr. Mayo said, “This procedure can release nerve pressure, address bicep tendon pain, prevent the need for joint replacement—for up to five years—and improve function for younger patients. There is minimal downtime from this surgery. Full recovery, however, is three to six months.”
   
• Shoulder Joint Sensory Nerve Ablation - a newer procedure that stops the sensory nerves of the shoulder from sending pain (electrical signals) to your brain. “The goal of this procedure,” said Dr. Mayo, “is to reduce pain and increase range of motion.” She added, “This is an appropriate option when conservative treatment is not working, medical conditions prevent surgery from being a safe option and/or there isn’t a way to work around the downtime necessary for shoulder replacement.”

Total Shoulder Replacement (TSR) Surgery and Recovery

“TSR is the surgical replacement of the abnormal surfaces that have been worn away by arthritis. It’s a good option for those with moderate to severe shoulder arthritis who have had little success with other treatments.” said Dr. Mayo.

She added, “The recovery from TSR surgery is not painful, but does take six to 12 months, and improvement can be seen for up to two years. You start with a sling for up to six weeks, no lifting is permitted for 12 weeks, PT begins almost right away and range of motion and activity progress incrementally.”

There are two types of TSR:

• Anatomic TSR - the most frequently performed TSR procedure. Dr. Mayo explained, “Your native ball is replaced with a metal ball and the native glenoid/socket is replaced with a plastic socket. It requires that your rotator cuff be intact.”
• Reverse TSR - recommended for those with severe deformity, who have experienced a previous fracture or for rotator cuff arthropathy. “It’s called a reverse TSR because we replace the ball with a socket and the socket with a ball. This means the patient no longer needs to depend on the rotator cuff for rotation,” said Dr. Mayo.

Schedule an Appointment

To schedule an appointment with Meredith Mayo, MD, call 303.502.9029 or visit BoulderCentre for Orthopedics & Spine.

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

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