Shoulder cartilage and arthritis

Overview

The two main bones that make up the shoulder (glenohumeral) joint are the scapula (shoulder blade) and the humerus (upper arm bone). Where these two bones meet, the glenohumeral joint, they are covered with cartilage. This allows for smooth joint motion with minimal friction. When there are injuries to this cartilage, joint motion can become painful, restricted, and no longer smooth. Injuries to the cartilage of the shoulder can vary in terms of the location and severity. They range from very small injuries in the cartilage on one side of the joint to complete loss of all cartilage on both sides of the joint.

When the injury affects only a small area, it is referred to as a focal cartilage defect. When the cartilage wear is larger or more diffuse, it is typically referred to as arthritis. While focal defects tend to occur in younger or middle age patients and arthritis tends to occur in older patients, both can occur in patients of any age.

  • Gradually increasing pain in the shoulder, especially with movement
  • Decreased range of motion
  • Shoulder weakness (typically due to the pain)
  • Some patients may even have a sensation of popping, clicking, or catching in the shoulder when attempting to move it

Seek care if you have pain in your shoulder that does not improve with rest. Typically, the pain progresses slowly over time, but if you have a sudden or sharp increase in pain, you should seek medical care. This is also true if you begin to notice decreased shoulder range of motion. Persistent and painful popping, clicking, or catching in the shoulder is not normal and should be evaluated.

Cartilage injuries in the shoulder can occur by a number of different mechanisms

  • Acute or sudden injuries to the shoulder such as a fall or dislocation
  • Chronic, long term over use or “wear and tear”
  • Following specific problems such as osteochondritis dissecans

There are a number of factors that increase your risk of a shoulder cartilage injury or arthritis, including:

  • History of significant shoulder injury
  • Participating in jobs that require long term, heavy lifting or manual labor
  • Powerlifting
  • Family history of cartilage problems or arthritis

Nonoperative management with focused physical therapy, activity modification, and anti-inflammatory medication is considered for most patients after they are initially diagnosed with a cartilage injury or arthritis. Many patients may be a candidate for an injection (corticosteroid or other products) to reduce the inflammation and pain in the shoulder. When these measures fail to relieve pain and symptoms, surgery is often considered. There are a number of surgical treatments for cartilage injuries/arthritis in the shoulder, and these range from simple arthroscopic debridement, cartilage restoring procedures, or shoulder replacement. Ultimately, all decisions regarding treatment must be individualized to the patient factoring in variables such as activity level, age, and location, size, and severity of the injury.  

Cartilage injuries and arthritis are very difficult to predict and prevent. However, early detection, activity modification, and receiving proper treatment in a timely fashion are likely the best ways to prevent these injuries from worsening over time.

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