Caitlin Whyte (Host): This is WakeMed Voices brought to you by WakeMed Health
and Hospitals in Raleigh, North Carolina.
Welcome.
I'm your host, Kaitlyn White.
With me is Dr.
Ryan Lee, an orthopedic sports medicine surgeon with Wake Orthopedics.
So today we are chatting all about shoulder arthritis.
Can you tell us what does that mean?
Dr. Ryan Li:
Arthritis is, a sort of a catchall for a couple different, diseases that
affect different parts of the body.
arthritis.
can affect any, joint that we have.
So, most commonly I think we hear about, the hip And the knee as common.
joints that are affected by arthritis.
other joints includes, the hands, the wrist, the elbow.
And in this case what we're talking about today is, the shoulder.
So basically any joint in the body That is meant to move,
can be affected by arthritis.
And arthritis is what happens when the lining of the joint, something called
cartilage, basically breaks down.
when we talk to patient's about.
a lot of times we talk about how it's almost like the tread
on your tires wears out so that normally, joints are meant to move.
joints are meant to glide against each other.
you have like a smooth layer of cartilage that glides against.
Each other.
And that provides like, you know, almost a lower friction surface
to glide And for joints to move.
So in arthritis, when we have the tread on your tires that wears out, it's basically
like the cartilage lining wears down.
So instead of cartilage, gliding on cartilage, a lot
of times in severe cases.
You have bone that's rubbing on bone, so cartilage doesn't have any nerve endings.
So a lot of times, when you are moving your elbow or your shoulder or any other
joint, you know, it should be painless.
But unfortunately, bone has a lot of, nerve endings so that
when you have bone rubbing on bone, that's a lot more painful.
the shoulder is pretty unique in the sense that, of all the joints in our
body, it probably has the most mobility.
So even though it's not a load-bearing joint, it actually
moves, it's got more degrees of freedom in moving than other joints.
And so just like any other joint, like the hip or the knee or the elbow, it
can also be affected by arthritis.
That can cause, painful and debilitating symptoms that affects
our, activities of daily living.
Caitlin Whyte (Host): Gotcha.
Well, you mentioned arthritis, could happen anywhere.
There's a joint, but how common is shoulder arthritis
and who tends to develop that?
Dr. Ryan Li:
so I would say that, there's a couple of different types of arthritis.
probably the most common type of arthritis is something called osteoarthritis.
and That is just mechanical wear, of the shoulder.
so that's basically just everyday wear and tear.
incidence of this increases with age, with increased age,
you have more people with,
both increased severity And the number of people who have arthritis.
alternatively there's other different types of arthritis as well.
So in people who have had, for example, fractures around the
shoulder, they can develop something called, avascular necrosis.
And that's basically where the blood supply to the ball of the shoulder dies.
And you can get.
Fairly rapid degenerative changes.
there's also a type of arthritis called rheumatoid arthritis, or inflammatory
arthropathies, which is often associated with, inflammatory conditions.
additionally in people with rotator cuff tears, eventually, if you have a rotator
cuff tear that's, you know, been there for a while, the, the fact that you
don't have a functioning rotator cuff can affect the biomechanics of your shoulder.
And so that can cause.
abnormal wear of your shoulder joint as well.
so even though there's a couple different types of arthritis, I would say that
most common type is, osteoarthritis.
And This is something that occurs more commonly, in older adults.
Caitlin Whyte (Host): Hmm.
So, it sounds like age is a factor.
Are there any other things that factor into developing shoulder
arthritis, maybe past injuries, activity level, other things like that?
Dr. Ryan Li:
This is a pretty in the sense that there's a couple different
factors that play into it.
anecdotally we see that in people who are laborers and who do a
lot of activity when, or whose.
You know, day-to-day jobs requires a lot of, heavy lifting a lot of physical
exertion that's going to create a lot more wear and tear on your shoulder.
additionally, people who have had surgeries.
In the past, I think are more prone to developing arthritis.
for people who have had, shoulder instability surgery or any kind of
surgery where their shoulder gets tightened up, they're at increased
risk for arthritis as well.
But overwhelmingly, I think the, the primary risk factor that we see is age.
Caitlin Whyte (Host): Well, what are some common symptoms that people might notice
when their shoulder is affected like this?
Dr. Ryan Li:
in shoulder arthritis, what we see is a gradual, increase in
pain, especially with activities.
So what we often find for people that, come into our clinic with
something like This is that they'll be complaining of symptoms that
never really started with any kind of acute injury or anything like that.
they kinda describe it as a deep ache in their shoulder that
gradually worsened over time.
sometimes the pain can wake you up at night.
Typically, pain is with activity, so any kind of reaching activity or any prolonged
activity with your shoulders, and unlike, something like a rotator cuff tear, for
example, the pain is usually more dull.
and again, it's, deeper.
almost an ache.
Some people describe it as a toothache.
Caitlin Whyte (Host): Interesting.
Well, if someone feels what you're describing and suspects that maybe
shoulder arthritis is the thing they've been dealing with, what are
the first steps they should take?
Dr. Ryan Li:
Because there's a lot of different things in the shoulder that can cause
pain, especially if it's something that really started on its own and
didn't coincide with an injury of any sort or anything like that.
This isn't one of those things where, you know, you lift up all of a sudden and
you feel apoB in your shoulder and all of a sudden you can't raise your arm up.
But for.
Issues that are more, I would say, gradual, and start increasing over time.
The first step is probably to try and manage this with home exercises.
there's a number of home exercises that we can find both, online And we
offer in the clinical setting as well.
you know, over-the-counter anti-inflammatories can help as well.
however, if.
any of those remedies don't help.
then the best thing to do is come on in and, see a physician to get
your shoulder evaluated, to see if This is something that we need
to worry about or whether This is something that can go away on its own.
Caitlin Whyte (Host): Well, in these early stages, are there any other
lifestyle changes that you would recommend that could maybe slow the
progression or relieve those symptoms?
Dr. Ryan Li:
I think that in general, a healthy lifestyle is important.
any home exercises, involving, you know, either band work or, lightweights, would
help to strengthen the rotator cuff, which is crucial In terms of, keeping
the shoulder healthy, oftentimes what we see is just like light exercises
for anywhere from 10 to 30 minutes a day can help to offload a lot of the
pain that people get from arthritis.
And that can, stave away a lot of the symptoms, especially from
early stages of shoulder arthritis.
Caitlin Whyte (Host): And then looking farther down the line, when
does surgery become an option, And what does that usually involve?
Dr. Ryan Li:
depending on what things look like, if a patient first comes into my
clinic, we'll basically evaluate them.
We'll typically get an x-ray of their shoulder.
and you can typically see one, if.
a patient has arthritis and two, how severe the degree of arthritis is.
our initial treatment is almost always conservative.
So either with home exercises, physical therapy, anti-inflammatory pain
medications, between those things and activity modifications itself, which,
you know, involves just refraining from a lot of the heavy lifting
exercises that, people are doing.
That can do a lot in terms of, Improving the symptoms.
if that does not work, then the next step is typically a cortisone
injection into the shoulder.
And this can provide pretty long lasting relief.
a cortisone injection, the time course of something like This is pretty variable,
but it can work from anywhere from a couple weeks to like over a year.
And so patient's will sometimes come in every, you know, 3, 6, 9
months and they'll get a cortisone injection in the shoulder.
And that's sort of like a, lower risk and less invasive way of
treating a lot of their symptoms.
What we've seen is that, patient's who get these injections, a lot of
them report almost complete resolution of their symptoms so they can go
back to their day-to-day activities.
and oftentimes, the injection something that we can typically just do in the
office, and people can basically, go back to their normal activities
either that same-day or the next day.
when it becomes a problem is that over time, the injections stop working.
So whether that's over the course of months or years or, you know, sometimes
almost a decade, but at some point the injections may stop working.
And if between that And the x-rays that show, pretty bad arthritis,
And we can typically see that.
based on how narrow the joint space is, a lot of times if they've failed
conservative treatment, then the next step would be surgery For this, surgery for for
shoulder arthritis works fairly similarly.
To surgery for, I think, hip and knee arthritis in the sense that
we put in a shoulder replacement.
So what we would do is to, basically cut the diseased, ball of the
shoulder and smooth out the disease socket of the shoulder.
So, essentially think about it like, we talked about a car earlier
where the tread had worn off.
So we would be basically putting on an artificial tread, to allow for that
shoulder joint to glide more smoothly.
So in this case, a lot of times we would put on a metal ball and a plastic
socket, And that would essentially function as, a patient's shoulder.
Caitlin Whyte (Host): Well, if it does come to the point of having this
surgery, what does recovery look like?
Dr. Ryan Li:
So typically surgery, takes about, two hours or so and, recovery.
is fairly long.
but, it is doable for most people.
in a portion of our patient's who are healthier, we can
actually do outpatient surgery.
So they get discharged the same-day.
other people.
come in and they stay overnight for one night.
typically recovery involves being in a sling for about six weeks.
they start physical therapy for regaining their range of motion,
typically within a week or so, surgery.
And most people are doing pretty well by about three months after surgery.
although what the latest data says is that time to maximum improvement.
For shoulder replacements, is typically between six months and a year.
Caitlin Whyte (Host): wrap it up for us today.
Doctor, what is your top advice for staying active and comfortable?
If you're living with shoulder arthritis.
Dr. Ryan Li:
I would say that, the most important thing is to make sure
you lead a healthy lifestyle.
watch your diet In terms of, exercises, remember to get
regular exercise for the shoulder.
Remember to strengthen your rotator cuff.
and even if you have shoulder arthritis, that doesn't necessarily
mean that you, absolutely need surgery or anything like that.
Most home exercises involving band work and lightweights can actually stave off
the symptoms of shoulder arthritis for a long period of time so that you can
actually avoid surgery in a lot of cases.
Caitlin Whyte (Host): Thank you so much for joining us today, Dr.
That was Dr.
Ryan.
to learn more about shoulder arthritis, visit wake ortho.com.
If you enjoyed this podcast, please share it on your social channels and
check out the entire podcast library.
For topics of interest to you, I'm Kaitlyn White with Wake Med Voices,
brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina.
Thanks for listening.