Saturday, November 9, 2013

What can be done for shoulder arthritis without surgery?


Non-operative treatment

Arthritis is a chronic condition - there is usually no rush in pursuing a surgical approach. The quality of life of a person with shoulder arthritis can often be improved by optimizing the person's overall health:
  1. regular aerobic exercise for an hour a day (walking, running, cycling, treadmill, stationary cycling, elliptical, swimming, etc).
  2. stopping smoking and alcohol consumption
  3. eliminating narcotic and sleeping medications
  4. healthy diet
  5. positive social interactions (dancing, volunteer work, church)
  6. getting outdoors (hiking, fishing)
  7. keeping the BMI under 25

In addition to these general health measures, there are some shoulder-specific therapies

A. Exercises
   1. Range of motion - In that stiffness is a prominent feature of arthritis, gentle range of motion exercises may be helpful in improving comfort and function. Each stretch needs to be held with gentle pressure for a full two minutes while the patient focuses on relaxation. How to stretch and how not to stretch
      a. Flexion
         i. Supine stretch
         ii. Pulley
         iii. Forward lean
      b. External rotation
      c. Cross body adduction
      d. Internal rotation
         i. Sleeper stretch
         ii. Up the back

2. Strengthening exercises – In that weakness from disuse may compromise the comfort and function of the shoulder, gentle progressive strengthening exercises may be helpful as long as they do not cause increased discomfort. A useful guideline is the ‘rule of 20’ i.e. exercises are likely to be helpful if they can be repeated comfortably for 20 repetitions. This performance level should be achieved before advancing the resistance of the exercises.
         i. Supine press
         ii. Latissimus pull
         iii. Rowing

B. Medications –Acetaminophen and non-steroidal anti-inflammatory medications may offer some symptomatic relief. However, these medications can have serious side-effects and patients need to be advised to follow the manufacturer’s dosing instructions on the bottle and to be made aware of potential hepatic, renal, marrow, cardiac and gastrointestinal complications. Here's a post about drugs for arthritis. Here are two posts about non-steroidal antiinflammatory medications (NSAIDS1)(NSAIDS2).

C. Injections
         i. Steroids + local anesthetic – these injections may be used to achieve temporary relief of symptoms. In some studies these injections have not been more effective than injection with saline alone. Repeated injection may damage cartilage and rotator cuff tendons.
         ii. Hyaluronic acid – while there have been some reports that these injections provide substantial relief; most data suggest they are no more effective than saline.

D. Arthroscopy
         Arthroscopy may be helpful in the management of early arthritis. See also here.
     
For more on things to be considered in the management of arthritis, click on this link.

When is the right time for shoulder joint replacement arthroplasty? Click on this link.
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**To see more of the Shoulder Arthritis Book, click here.**


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