Injuries, broken bones, long-term on-the-job strain, and even normal use can all lead to osteoarthritis in the main joint of the shoulder, the so-called glenohumeral joint. This joint is located where the humeral head (the top of the upper arm bone) meets the shoulder socket, and gives the arm its great mobility. Arthritis in the main joint of the shoulder has an impact on almost all activities in which the arms and hands are used. Therefore, this type of osteoarthritis can often place serious limits on work, sports, and everyday activities.

Instead of the main joint, osteoarthritis may also affect a small and relatively little-known joint at the top of the shoulder. It is called the AC joint, or acromio-clavicular joint, because it is located where the "acromion”  (sometimes called “roof of the shoulder”) meets the “clavicle,” or collarbone. Doctors sometimes refer to osteoarthritis in this joint simply as “AC joint arthritis.” It often, but not always, causes pain when you reach across the body or up and forward.

In rare cases, osteoarthritis symptoms can occur in a joint that is actually far from the main shoulder joint, but still part of the so-called shoulder girdle. This joint is found where the clavicle, or collarbone, meets the  sternum, or breastbone. When osteoarthritis develops in this joint, the pain may sometimes initially be mistaken for cardiac pain. At later stages, a slight enlargement of the joint can be noticed, accompanied by a characteristic pain felt when reaching up or across the body.

Doctors frequently use two simple tests to check for limited motion from shoulder osteoarthritis:
(1) “Tying an apron.” Does it hurt to reach behind your back, as in tying an apron?
(2) “Combing your hair.” Can you raise your hand to your head and  then move it back and down your neck, or does this hurt?
If you can perform both tests without pain or limitation, then the joints of your shoulder girdle are probably quite healthy. These tests are frequently repeated during therapy, in order to document progress.

What position will allow your shoulder to heal the fastest when you are suffering from acute pain? In cases of serious pain, doctors sometimes recommend and prescribe one of these two types of immobilization:
(1) a shoulder abduction pillow, or
(2) a special orthosis or splint.
Both devices can help the painful shoulder joint improve more quickly, and stiffness of the main joint can usually be prevented. Whenever    possible, however, immobilization should be avoided. Instead, gentle range-of-motion exercises may help relieve pain and stiffness.

Healthy people who have not experienced shoulder problems may find it hard to imagine how quickly generalized stiffness of the main shoulder joint can occur, and how much tedious treatment is necessary to reverse this condition. A common cause of shoulder stiffness is wearing an arm sling for too long. Arm slings should not be considered a convenient form of self-help – in fact, they can do serious harm to the shoulder. If you have shoulder problems, please remember never to wear an arm sling for an extended period of time unless your doctor advises you to do so!

Any work that requires you to reach up over your head can put increased strain on your shoulder joints. If you have shoulder osteoarthritis, it is   best to avoid work like wallpapering and painting. Washing windows, hanging out laundry, or placing items on high shelves should only be done with care, using helpful devices (e.g. a household ladder) whenever possible. This will help you avoid irritation of the affected shoulder joints.

In many acute cases, using ice during or after physical therapy can be helpful. Once the acute pain has subsided, however, many patients find the careful application of heat to be more comfortable and beneficial. Your doctor will advise you which kind of heat application will be best for you. Many rehab centers also recommend alternative sources of heat relief such as the “cherry pit pillow,” which can be found at farmers’ markets or ordered online, e.g. at www.cherrypitstore.com.

Arthroscopy or “scoping” may be used to treat some cases of shoulder  osteoarthritis. If mechanical blockage is present, it may be helpful to remove free-floating cartilage particles and scar tissue and to clean and irrigate the inside of the joint. This may produce some improvement for several months. For best results, it is important to follow up with physical therapy after arthroscopic treatment. Shoulder joint replacement will be presented in an upcoming issue.

Immobilizing the shoulder with a sling for a short time, as well as using salves, medications, or injections  prescribed by your doctor, can often provide effective pain relief. Once the pain has subsided, further therapy is directed towards regaining mobility. There are several exercises you can do at home: for example, swinging with a light weight (1 lb.) while lying down. These exercises can be learned from a physical therapist and then practiced several times daily at home, for 5 to 10 minutes each time. Aquatic exercises or “finger walking” up a door can also be beneficial.

After your pain has subsided even further, you might want to try this simple exercise. It consists of two parts:
(1) Clasp both hands behind the neck.
(2) Slowly spread your elbows away from your head.
You can do this exercise while sitting or while lying down. The stretching effect will be greatest if you perform these movements slowly and carefully. This exercise only takes about a minute, and can be repeated several times a day.

With osteoarthritis of the shoulder, athletic activities that could cause shoulder strain from impact or falls should be modified or avoided. These include football, basketball, handball, volleyball, tennis, javelin throwing, or playing goalie in soccer. Instead, you may want to try swimming breaststroke, using very slow and careful movements. Taking walks and exercising on a stationary bike are also generally safe and healthy choices.