Arthritis Pain of the Shoulder

Abstract

The shoulder joint is susceptible to the development of arthritis from various conditions that cause damage to the joint cartilage. Osteoarthritis is the most common cause of shoulder pain and functional disability. It may occur after seemingly minor trauma or may be the result of repeated microtrauma. Pain around the shoulder and upper arm that is worse with activity is present in most patients suffering from osteoarthritis of the shoulder. Difficulty sleeping is also common, as is progressive loss of motion. Most patients presenting with shoulder pain secondary to osteoarthritis, rotator cuff arthropathy, or posttraumatic arthritis complain of pain that is localized around the shoulder and upper arm. Activity makes the pain worse, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Some patients complain of a grating or popping sensation with use of the joint, and crepitus may be present on physical examination.

Keywords

shoulder pain, osteoarthritis, acromioclavicular joint, glenohumeral joint, rheumatoid arthritis, gout, intraarticular injection shoulder, frozen shoulder, brachial plexus block

ICD-10 CODE M19.90

The Clinical Syndrome

The shoulder joint is susceptible to the development of arthritis from various conditions that cause damage to the joint cartilage. Osteoarthritis is the most common cause of shoulder pain and functional disability ( Fig. 25.1 ). It may occur after seemingly minor trauma or may be the result of repeated microtrauma. Pain around the shoulder and upper arm that is worse with activity is present in most patients suffering from osteoarthritis of the shoulder. Difficulty sleeping is also common, as is progressive loss of motion.

Signs and Symptoms

Most patients presenting with shoulder pain secondary to osteoarthritis, rotator cuff arthropathy, or posttraumatic arthritis complain of pain that is localized around the shoulder and upper arm. Activity makes the pain worse, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Some patients complain of a grating or popping sensation with use of the joint, and crepitus may be present on physical examination.

In addition to pain, patients suffering from arthritis of the shoulder joint often experience a gradual reduction in functional ability because of decreasing shoulder range of motion. This change makes simple everyday tasks such as combing one’s hair, fastening a brassiere, or reaching overhead quite difficult. With continued disuse, muscle wasting may occur, and a frozen shoulder may develop.

Testing

Plain radiographs are indicated in all patients who present with shoulder pain ( Fig. 25.2 ). Based on the patient’s clinical presentation, additional testing may be indicated, including a complete blood count, erythrocyte sedimentation rate, and antinuclear antibody testing. Computerized tomography may help identify boney abnormalities. Magnetic resonance and ultrasound imaging of the shoulder are indicated if a rotator cuff tear or other soft tissue pathology is suspected ( Figs. 25.3 and 25.4 ). Radionuclide bone scanning is indicated if metastatic disease or primary tumor involving the shoulder is a possibility.