Caitlin Whyte (Host): This is WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Welcome. I'm your host, Caitlin Whyte. With me is Dr. Ryan Li, 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 patients about it, a lot of times we talk about how it's almost like the tread on your tires wears out. So 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.

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. This 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 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.

Host: 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 pretty multifactorial 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 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 primary risk factor that we see is age.

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 kind of 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. It's almost an ache. Some people describe it as a toothache.

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 a pop 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.

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.

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, patients will sometimes come in every, you know, three, six, nine 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 patients 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 is 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 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 thread 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 patients shoulder.

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 patients 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 of 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.

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.

Host: Thank you so much for joining us today, Doctor. That was Dr. Ryan Li. To learn more about shoulder arthritis, visit wakeortho.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 Caitlin Whyte with WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Thanks for listening.