There are a number of possible treatments that will be determined by the type and extent of the arthritis. Initially, non-surgical treatments will normally be recommended including:
- An exercise program to improve the range of motion in the joint, build strength and learn how to perform everyday actions without exacerbating the pain.
- Anti-inflammatories and painkillers.
- Injections of corticosteroids into the joint to reduce pain and inflammation.
- Injections of hyaluronic acid into the joint to increase lubrication and reduce pain.
- Drugs to treat rheumatoid arthritis – following a review with a Rheumatologist.
Surgery
When the pain of arthritis becomes severe, you may be offered surgery. There are a number of surgical treatments for the common types of arthritis in the shoulder and elbow depending on the type of arthritis and the severity. Ultimately joints can be fully replaced, which is often called arthroplasty.
Acromioclavicular joint arthritis:
Arthroscopic resection – this is a minimally invasive (keyhole) surgical procedure to remove the worn out rubbing bone surface. It involves making a small incision in the skin and inserting an arthroscope, which is a tiny tube with a camera at one end that allows the surgeon to see inside the joint. Tiny surgical tools are inserted through further incisions in the skin to remove the end of the collarbone in the joint and prevent painful catching.
Open removal of the distal clavicle – this may be used if there are large spurs at the end of the collar bone requiring a bigger cut to remove them fully.
Shoulder ball and socket (glenohumeral joint) arthritis:
- Arthroscopic debridement – this is a minimally invasive (keyhole) surgical procedure to remove rough bone surfaces and loose debris and release tight tissue creating stiffness. Sometimes early arthritis or cartilage damage can be treated with keyhole surgery techniques to try and fill holes and prevent further cartilage damage
- Open debridement – this isn’t commonly used for shoulder arthritis but may allow removal of abnormal bone or tissue causing pain and stiffness.
- Anatomic total shoulder replacement – this involves replacing both the head of the humerus and the shoulder socket with a metal and plastic joint of a similar shape and size.
- Reverse total shoulder replacement – this involves replacing the ball and socket joint by swapping the socket for a ball attached to the shoulder blade and placing a cup at the top of the arm bone. This complicated replacement allows the arm to lift using the outside shoulder muscles (deltoid) when there may be damage or failure of the rotator cuff muscles.
- Hemiarthroplasty – involves replacing just the head (ball) of the humerus.
Elbow Joint
- Arthroscopy – this is a minimally invasive (keyhole) surgical procedure to remove some of the bone spurs and loose fragments whilst releasing tight linings around the joint. Small patches of damaged cartilage can sometimes be treated with keyhole techniques to prevent further damage and fill any holes.
- Open debridement – if there are large bone spurs then an open operation through a larger cut may allow the surgeon to remove bone and scar tissue to relieve painful catching and improve movement. This type of operation is sometimes called an ‘OK’ procedure.
- Elbow joint replacement – for severe arthritis an elbow joint replacement can replace part or all of the hinge of the elbow. This complex procedure should be performed by an expert in a major orthopaedic centre such as Nottingham. It is excellent for relieving pain and improving movement but there are limits to the weight that can be lifted after the procedure to protect the joint in the long term.