Degenerative Joint Disease

Osteoarthritis, or Degenerative Joint Disease (DJD), of the shoulder is not as common as that in the hip or knee, but when it occurs, can be both painful and disabling. It is usually very gradual in progression (over a year or more).

The normally shiny surface of the “ball” (the upper end of the humerus or arm bone) functions like Teflon to insure a smooth frictionless movement. With DJD, this surface breaks down either from wear and tear or another primary process such as rheumatoid arthritis. When this happens, the surface wears away leaving a painful bone-on-bone situation. Although DJD can occasionally manifest in your 50’s, it is mostly in their late 60’s, 70’s and 80’s when patents notice pain and impairment.

Treatment options can be limited. Initially, activity modification, medication and injections can be effective. Therefore, if you have been told to “live with it as long as you can,” it might be a good idea to at least find out if some of the more conservative measures can be effective in this early stage.

Unfortunately, physical therapy usually has little to offer in the treatment of this condition. Factors that force consideration of more aggressive management include hand dominance, the inability to sleep and impairment of activities of daily living. Aggressive treatment for such symptoms unfortunately requires surgery – either resurfacing of one side of the joint (hemiarthroplasty) or resurfacing of both sides of the joints (total shoulder arthroplasty). If surgery is the only option, there is usually no urgency as the progression of the disease is slow. Most patients can choose a time for surgery that is convenient.

The surgical concept used is identical to that for similar problems of the hip and knee where a metal component is fitted on one side and a high tech polymer component on the other. This approach is generally very effective in reducing pain. Functional recovery is proportional to the condition of the rotator cuff. In most cases, there has been long standing stiffness leading to contracture of these muscles. With re-establishment of a smooth, congruent shoulder joint, this stiffness becomes the focus of rehabilitation. Postoperatively, patients are guided in a home exercise program and advanced to formal physical therapy when appropriate. Most patients can drive within 2-3 weeks and may return to reasonable activities within 6 weeks (golf at 12 weeks). Overall, however, continued improvement can be seen over 6 months with maintenance exercises done at home on a routine basis (the exercises usually take less than 10 minutes).

At OSA, we have more than 30 years combined experience in total shoulder arthroplasty and have been involved nationally in the development of surgical devices as well as instruction of other surgeons in their implantation.