What is Osteoarthritis of the Shoulder?
Arthritis means ‘wear & repair’ of the joints. Osteoarthritis (OA) is the most common form of arthritis in the UK. OA mainly affects the joint cartilage and the bone tissue next to the cartilage.
What causes osteoarthritis?
All normal joints and joint tissues are constantly undergoing some form of repair because of the stresses and strains that are placed on them through our daily activities. However, in some people, it seems that this repair process becomes faulty in some way and OA develops. In joints with OA, the joint cartilage becomes worn. The bone tissue next to the cartilage can also be affected and bony growths can develop around the joint edges. These growths are called osteophytes and may be seen on X-rays. The joints and the surrounding tissues can also become inflamed. This inflammation is called synovitis.
Factors that may play a role in the development of OA include:
- Age: OA becomes more common with increasing age. By the age of 65, at least half of people will have some OA in some joint(s).
- Genetics: There may be some inherited tendency for OA to develop in some people.
- Obesity: Shoulder OA is more likely to develop, or be more severe, if you use your arms for weight-bearing e.g. pushing up from a chair or using walking aids.
- Your sex: Women are more likely to develop OA than men.
- Previous joint injury, damage or deformity: This may include previous joint infection, a previous fracture (break in the bone) around a joint, or a previous ligament injury that caused a joint to become unstable.
- Occupation/Sport: Shoulder issues are more prevalent with people who use their arms above shoulder height in a repetitive or sustained way, especially when heavier loads are involved.
- Posture: Becoming stooped and round shouldered puts more stress on the shoulder joint when performing normal movements.
What are the symptoms of osteoarthritis?
- In some cases no symptoms may occur. Quite a number of people can have X-ray changes that indicate some degree of OA but have minimal symptoms.
- Pain, stiffness, and limitation in full movement of the joint are typical. The stiffness tends to be worse first thing in the morning but tends to loosen up after half an hour or so.
- Swelling and inflammation of an affected joint can sometimes occur.
- An affected joint tends to look a little larger than normal. This is due to overgrowth of the bone next to damaged cartilage.
- If you have a lot of OA in your shoulder, you may have difficulty in putting your clothes on, and using the arm above shoulder height
- Pain at night may be an increasing problem with advancing OA.
Do I need any tests?
Your doctor can often diagnose osteoarthritis based on your age, your typical symptoms and examination of your affected joints. Tests such as X-rays or blood tests are usually not needed. However, sometimes your doctor may suggest X-rays or other tests if they are uncertain about the diagnosis and want to exclude other problems, and also to decide what the best management is.
What is the outlook for people with osteoarthritis?
The severity of symptoms can vary. In many people, OA is mild and does not make you any more disabled than expected for your age. However, in some people, the severity of OA and the disability it causes is out of proportion to your age.
Management of osteoarthritis
Exercise
If possible, exercise regularly. This helps to strengthen the muscles around affected joints, to keep you fit, and to maintain a good range of joint movement. You may be referred to a physiotherapist.
Weight control
If you are overweight, try to lose some weight.
Painkillers and anti-inflammatory medicines
These can be prescribed by your GP or pharmacist as a temporary measure to break the cycle of pain and aid sleep.
Steroid injections
These can be used to reduce pain and inflammation when the pain is constant and severe.
Surgery
Joint replacements may be considered if all conservative management options are not helping. A referral to see an orthopaedic consultant may be recommended.
What are the aims of physiotherapy?
The aim of physiotherapy is to increase joint mobility, improve muscle strength and try and relieve pain.
What actions can I take to improve my health?
Evidence tells us that making healthy lifestyle choices can have a big impact on influencing problems with your muscles and bones and can play a major role in your overall health. Some of the most effective areas to address are below:
Maintaining a healthy weight:
Link: www.nhs.uk/live-well/healthy-weight/
Increasing levels of physical activity
Link: www.nhs.uk/live-well/exercise/
Avoiding poor sleep patterns
Link: www.nhs.uk/live-well/sleep-and- tiredness/how-to-get-to-sleep/
Reducing alcohol consumption
Link: www.nhs.uk/live-well/alcohol- support/calculating-alcohol-units/
Stopping smoking
Link: www.nhs.uk/live-well/quit-smoking/
Maintaining a healthy mind
Link: www.nhs.uk/conditions/stress-anxiety-depression/
The good news is that you are able to influence lots of these by modifying your lifestyle. Therefore it is important that you consider addressing these areas alongside your current treatment.
You may wish to discuss any of these factors with your treating clinician who will be able to work with you and guide your long term management and support you to improve your wellbeing.
There will be information about the local services that exist within the waiting areas of the physiotherapy department and your treating clinician will be able to help signpost you to appropriate services.
The websites listed below give more information on local services available:
• Blackburn and Darwen - https://refreshbwd.com/
• East Lancashire - http://www.upandactive.co.uk/
Applications (Apps)
The ORCHA website will recommend useful and rated apps to support your wellbeing. https://www.orcha.co.uk/
Aims of Physiotherapy:
Physiotherapy may form one part of your management, helping you identify the main contributory factors whilst working together to plan your rehabilitation.
Your physiotherapist may spend time talking with you about your shoulder pain, providing advice, reassurance and helping discuss any concerns you may have.
A physiotherapist can provide and help oversee a personalised exercise programme focused on what you want and need your body to achieve.
If your symptoms fail to improve within 6 weeks with this regime you should contact your doctor for a physiotherapy referral.
