I have shoulder arthritis – What are my options for treatment?

I have shoulder arthritis – What are my options for treatment? Do I need surgery? Do I need a total shoulder replacement? Do I need a reverse total shoulder replacement?

Shoulder arthritis Q&A with Dr. Brent J. Morris, MD a shoulder replacement specialist in Lexington, Kentucky at Baptist Health Lexington – Orthopedics and Sports Medicine.

 Who is Dr. Brent J. Morris?

Dr. Brent J. Morris is an orthopedic shoulder and elbow surgeon in Lexington, Kentucky at Baptist Health Lexington – Orthopedics and Sports Medicine. Dr. Morris is a fellowship-trained shoulder and elbow specialist with additional interest in primary and revision total shoulder replacement surgery.  Dr. Morris is co-author of a textbook devoted to total shoulder, reverse total shoulder, and revision shoulder replacement surgery, Shoulder Arthroplasty, 2^ndEdition.

SHOULDER JOINT ARTHRITIS

Figure 1. Right shoulder joint primary osteoarthritis (OA)

Non-surgical Treatment of Shoulder Arthritis

An initial trial of non-surgical treatment is warranted before consideration of surgical treatment with shoulder replacement surgery.

Conservative or Nonoperative/Nonsurgical Treatment Options:

1. Activity modifications (less use of the painful shoulder, especially overhead use)
2. Anti-inflammatory medications (NSAIDs)
3. Corticosteroid injections into the shoulder joint
4. PRP (platelet-rich plasma) – limited data to support at this time for shoulder arthritis
5. Stem cell injections – limited data to support at this time for shoulder arthritis
6. Scapular stabilization or gentle range of motion exercises – these are meant to be light/stretching exercises

Other Injections to Consider?

Should you consider PRP injections, stem cell injections, or “gel” injections for your shoulder arthritis?

I think it is important to discuss “other” injections so you are aware of the options that are out there and discussed, sometimes with limited proven benefits.

PRP injections – PRP or platelet-rich plasma injections are largely unproven in the setting of shoulder joint arthritis. There are not felt to be many risks with a PRP injection for shoulder arthritis; however, there may also be few benefits. 

PRP injections remain a “cash-pay” procedure as insurance companies do not currently cover the cost of PRP injections for shoulder arthritis given the limited proven benefit at this time for shoulder arthritis.  Unfortunately, there is NOT good evidence to support the use of PRP injections for shoulder joint arthritis at this time.; therefore, I do not perform PRP injections for shoulder joint arthritis.

Stem cell injections – there are many forms of stem cells that can be injected; however, stems cells have NOT been proven to be effective for curing shoulder joint arthritis.  There may eventually be a role for stem cell injections and shoulder joint arthritis; however, the role of injectable evidence for shoulder arthritis is lacking at this time. 

Similar to PRP, stem cell injections are “cash-pay” as insurance companies do not currently cover the cost of stem cell injections for shoulder arthritis given the limited proven benefit at this time for shoulder arthritis.  Unfortunately, there is NOT good evidence to support the use of stem cell injections for shoulder joint arthritis at this time.; therefore, I do not perform stem cell injections for shoulder joint arthritis.

“Gel” injections – many people ask about “gel” or “rooster comb” injections for shoulder arthritis given the application for knee arthritis.  Gel injections are hyaluronic acid derivatives.  Unfortunately, there is NOT good evidence to support the use of “gel” injections for shoulder joint arthritis at this time.; therefore I do not perform gel injections for shoulder joint arthritis.

Are pain medications (opioid medications) recommended? 
We do not advocate for pain medications.  NSAIDs and muscle relaxants are safer medications to consider.  Pain medications do not treat the underlying problem (arthritis) and numb your brain and put you at risk.  We reserve pain medications to help with pain after surgery (whenever surgery is necessary) for the first one to two weeks after surgery.

Minimally Invasive Surgery as an Option

Is minimally invasive (arthroscopic) surgery an option for my shoulder arthritis?

Unfortunately, there are limited benefits for arthroscopic or minimally invasive shoulder surgery for end-stage shoulder arthritis.  I often tell patients it is a “coin toss” at best meaning there is a 50-50 chance they may see some benefit from an arthroscopic “clean out” or debridement procedure, but others may see no benefit at all because a shoulder scope alone cannot fully address end-stage arthritis of the shoulder joint. 

Minimally invasive (arthroscopic) shoulder surgery for shoulder arthritis is typically limited to very young patients as a last resort prior to considering a total shoulder replacement.  A total shoulder replacement is superior to an arthroscopic debridement in the majority of patients with shoulder arthritis.  It is rare to find an indication for arthroscopic debridement for severe shoulder joint arthritis. 

Patient-Physician Shared Decision Making

The main thing a patient has on their side is time.  Shoulder replacement surgery is an “elective” surgery meaning the patient gets to choose IF and WHEN they would like to proceed with surgery. 

IF the shoulder pain is severely debilitating and life-limiting then it is very reasonable to consider total shoulder replacement WHEN the patient desires to proceed after discussion with their family.  It is important to select an orthopedic surgeon that is trained in shoulder replacement surgery, typically a fellowship trained shoulder replacement specialist.

The Bottom Line:

Shoulder arthritis is not a life or limb threatening condition, but it remains a painful condition especially when it continues to worsen over time.

The decision for shoulder replacement surgery (total shoulder replacement or reverse total shoulder replacement) is a very personal decision.  I recommend that patients think it over and pray about it and discuss with their families prior to proceeding with surgery. 

Fortunately, the majority of the patients with end-stage arthritis that proceed with surgery do have a successful outcome and are satisfied with their results after surgery.