Epidemiological data reveals that osteoarthritis is the leading cause of disability in the US, whereas on a worldwide basis, osteoarthritis is the most common joint disorder that affects normal joint function. Despite the fact that osteoarthritis of the shoulder is not as ‘‘widespread’’ as osteoarthritis of the hip or knee, research indicates that it affects 32,8 % of patients over the age of 60 and causes equally severe degeneration– women are more likely to develop osteoarthritis compared to men. In fact, statistical information from surgical operations assessed by orthopedists, presents the significant disparity between hip or knee surgeries and shoulder surgeries. Orthopedists point out that the outcome is due to the fact that individuals who suffer from osteoarthritis of the shoulder tolerate the symptoms for a longer period of time· patients only visit the doctor when the pain is significantly affecting their sleep and quality of life.
The acromioclavicular joint (the joint between the clavicle and acromion) in the shoulder girdle can develop arthritis, as well as the glenohumeral joint (the joint between the humerus and scapula). In patients over the age of 50, the primary cause of arthritis is cartilage degeneration in the course of time– the thin layer of connective tissue that provides a smooth surface between the bones, and acts as a shock-absorber during shoulder movements. Progressive deterioration of cartilage leads to the glenoid cavity coming into contact with the humeral head and causes excruciating pain, followed by subchondral sclerosis, reduction of the distance between the articular surfaces, as well as the development of cysts and osteophytes.
On the contrary, age is not a determining factor in the development of rheumatoid arthritis, a chronic disorder that affects multiple joints simultaneously. The synovial membrane becomes inflamed and thickens, leading to pain and joint stiffness. It is an autoimmune disorder: The body’s immune system attacks and destroys healthy body tissue (cartilage, ligaments, bones).
The third type of arthritis is post-traumatic arthritis. It can develop after a sustained physical injury, for example fracture, dislocation or muscle tear.

The patient’s pain is initially mild and associated with joint movements. The progression of osteoarthritis is normally gradual, and in its acute stage, the entire shoulder is affected and symptoms worsen when changes in the weather occur. All movements gradually become more painful, even at night time and when the patient rests. Additional major symptoms include limited active and passive range of motion, stiffness and inflammation, as well as a grating sensation reported by a large number of patients. 

Diagnosis is based on the detailed medical history of the patient, combined with clinical examination that could reveal focal muscular atrophy, lesions or injuries of the muscles, tendons and ligaments in the joint, and in cases of rheumatoid arthritis, the recommenced examination of other joints that could possibly be affected. Conventional treatment aims to relieve pain and maintain (if not improve) the joint’s range of motion. Rest is recommended by the doctor, especially in acute stages, as well as ice packs, painkillers, nonsteroidal anti-inflammatory drugs, intraarticular injections (cortisone, hyaluronic acid), and physiotherapy.
In cases of unsuccessful conventional treatment or advanced stage osteoarthritis with severe symptoms, shoulder arthroplasty is chosen as the appropriate treatment. In accordance with the patient’s age, and whether the patient suffers from glenohumeral or acromioclavicular arthritis, the surgeon suggests a suitable surgical technique. In young patients, arthroscopic debridement is a possible surgical option.
The glenohumeral joint is replaced, either in its totality or partially, by replacing the upper part of the humerus (partial joint arthroplasty). In cases of decreased muscle function of the rotator cuff muscles or loss of function of the axillary nerve, reverse shoulder arthroplasty is the selected treatment option. In cases of acromioclavicular arthritis, treatment usually involves the removal of a small part in the lateral end of the clavicle (excision arthroplasty, commonly known as Mumford procedure).
Postoperatively, the patient must wear a cast for 3 to 6 weeks and follow a program that includes physiotherapy sessions and muscle strengthening exercises. Complete rehabilitation, in other words,      a restored range of motion of the shoulder without any associated pain, is estimated to happen in a 3 to 4 months period.  

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