What is shoulder arthritis?

肩关节关节炎是肩关节内部软骨的损伤. The shoulder has two joints. 肩关节关节炎通常是指更大的球窝关节，以其连接的骨头(肩关节和肱骨)命名为盂肱关节。. 软骨覆盖球(肱骨头)和窝(肩关节)。.

当肩膀上的软骨开始从表面到深层分解, it’s called shoulder arthritis. The second joint in the shoulder, the acromioclavicular or AC joint, can also develop arthritis known as AC joint arthritis.

How does shoulder arthritis develop?

肩关节关节炎通常是由软骨逐渐磨损和撕裂引起的. Cartilage is present in every joint in the body; it covers the surface of the bones inside the joints similar to Teflon on a ball bearing. 软骨是一种2到3毫米厚的活组织，大约有一到两层硬纸板的厚度. This makes the contact between bones softer. If the cartilage is intact, 它可以进行多次旋转而不会磨损表面，因为它是光滑的.

Shoulder arthritis typically develops in stages. First the cartilage gets soft (A), then it develops cracks in the surface (B), then it begins to “fibrillate” (deteriorate and flake) (C), 最后它会磨损露出骨头的表面(D). 其结果是，它失去了作为光滑、滑行表面的能力.

关节表面的软骨不会一次全部磨损. Instead, it wears at different rates in different parts. 如果你考虑球轴承的表面被特氟龙覆盖, 这种类型的磨损就好像特氟龙有凹坑，表面现在是不规则的(见下图)。.

一旦表面变得不规则，软骨可能会受到进一步的损伤. It may begin to thin out, 最终导致肩胛骨相互摩擦(第四阶段软骨丢失). 很多人认为关节炎是关节的骨对骨牵引, 但实际上关节炎是导致骨对骨牵引力的过程.

我们不可能知道肩关节关节炎会以多快的速度恶化. 每个人的肩关节软骨都有不同程度的损伤. 通常，当某些活动产生疼痛时，这意味着软骨正在承受压力. Generally, the more painful the activity, 就越有可能进一步损伤软骨和肩关节.

Causes and Types of Shoulder Arthritis

There are several different forms of shoulder arthritis. 每一种可能都有不同的起源，一些引起肩关节炎的原因仍然未知.

Osteoarthritis of the Shoulder

Osteoarthritis is also known as degenerative joint disease. It is often associated with wear and tear related to aging. 它还可以影响除肩膀以外的其他关节，是最常见的关节炎形式.

Rheumatoid Arthritis of the Shoulder

Rheumatoid arthritis is an autoimmune disorder, which means your body attacks your own healthy cells, which may include the lining of the joint. 这种炎症性关节炎可以同时出现在两个肩膀.

Post-Traumatic Shoulder Arthritis

If your shoulder was fractured, dislocated or otherwise injured, you may develop post-traumatic arthritis.

Rotator Cuff Tear Arthropathy

肩袖撕裂性关节病是一种肩关节关节炎，可在大规模和长时间的肩袖撕裂后发展. 你肩膀上的四个肩袖肌腱包裹着肩关节的球形部分, holding it in place. If one or more of these tendons is heavily torn, 这可能会导致肱骨头与其他骨骼摩擦并发展为关节炎.

Shoulder Arthritis Due to Avascular Necrosis

Avascular necrosis refers to the disrupted blood supply to an area of the body, which results in that area dying (necrosis). In the shoulder, 肱骨头(肩关节球)可能因疾病而失去血液供应, traumatic injuries, and other causes. 没有血液供应，骨骼会慢慢塌陷，变得不均匀，导致关节炎.

Shoulder Arthritis Symptoms

软骨损失的程度因人而异，肩关节的症状也是如此:

• Pain in the shoulder joint is the major sign of arthritis. It can be present in the front, side or back of the shoulder. 有些人即使不使用手臂也会感到疼痛，有些人只有在使用手臂时才会感到疼痛. 关节炎疼痛可以发生在一天中的任何时间，可以与肩僵硬或不存在. 通常在举重、搬运重物或运动后疼痛会更严重. 这种疼痛通常会扩散到手臂，如果严重的话，还会扩散到肘部和手腕.
• Stiffness of the joint is another sign of shoulder arthritis progression. 你可能会因为肩部活动范围的减少而感到僵硬. As the motion decreases, you may find that you can do fewer things with your arm, and these activities may be limited due to pain.
• Grinding, clicking or cracking (crepitus) 可自感觉软骨表面不规则与关节炎有关. It may or may not be painful. Sometimes the shoulder may “lock up.” Occasionally, because the surfaces are no longer smooth, you may feel the shoulder slide in certain positions.

Shoulder Arthritis Diagnosis

To diagnose shoulder arthritis, 你的医生会给你做身体检查，询问你的症状和病史. 关节炎的程度和骨臼的骨量可以通过x光片或检查来评估和确认, if needed, with a CT scan.

Shoulder Arthritis Treatment

Range-of-Motion Exercises

肩关节关节炎的初始治疗是药物(非手术)治疗. 它通常从活动范围练习开始，以保持肩部的活动. 如果你的活动范围没有受到影响，那么目标就是防止它恶化. 由于关节炎导致的肩关节运动能力丧失通常是渐进的，很难注意到. 随着关节变得僵硬，疼痛和活动能力也会恶化. 建议每天做两到三分钟的伸展运动, whether you have a loss of motion or not.

肩关节关节炎的物理治疗通常不需要，除非你失去了活动范围. 通常不建议对患有关节炎的肩部进行强化训练, as in some instances it could cause more pain. 然而，如果运动对肩膀没有影响，那么它们是完全可以做的.

Lifestyle Modifications

第二种治疗方法是在合理的范围内避免使肩膀疼痛的事情. Generally, anything that causes pain should be avoided, especially if the pain interferes with your life. 如果肩痛持续数天，晚上会醒来, 质疑这项活动对你有多重要可能是合理的. For example, if you have pain while playing golf, 也许有必要减少到每周一次，而不是每天都玩.

Pain Control

The third medical treatment is to try to control the pain. This can be done in several ways:

• Ice is your friend. 冰袋对疼痛很有效，如果需要的话，一天可以使用一次或几次. 你可以使用一袋冰或一个冷疗垫，可以放在冰箱里重复使用. 冰袋应该放在前面、顶部和肩膀后面. It can be used for 20-30 minutes at a time. 如果疼痛让你在晚上醒来，考虑在睡觉前冰敷肩膀.
• Some people feel that heat is a better treatment for shoulder arthritis pain. 在拉伸之前，加热通常有利于关节的预热, but you should use whatever strategy provides the best relief.
• Medication 也可以用来控制疼痛，但它们都有各自的好处和潜在的并发症吗. 与你的初级保健医生或外科医生讨论你的药物，以确保你没有任何理由避免服用某些药物.

Which medication can I use for my shoulder arthritis?

You could start with acetaminophen since it has few side effects. However, it can affect the liver if used in high doses, so consult with your physician about the best dose. 下一类缓解肩关节症状的药物被称为非甾体抗炎药(NSAIDs). 大多数非甾体抗炎药只能在疼痛出现时服用，根据需要提供缓解. 如果你需要更持久的疼痛缓解，和你的医生谈谈. Also, 如果你有出血和溃疡史，不应该服用非甾体抗炎药, are on blood thinners, have kidney failure, certain heart diseases or other conditions. 在服用非甾体抗炎药之前，你应该和你的医生讨论这些问题.

Injections for Shoulder Arthritis

目前有两种类型的注射可以缓解肩部关节炎的疼痛. The first type is cortisone shots. Typically, 可的松与一种麻醉剂混合，可以立即缓解疼痛，并帮助你的医生知道注射是否在正确的地方. 一旦麻药药效消失，关节可能会疼痛，直到可的松开始起作用. 重要的是在注射后将肩膀冰敷一天左右.

Cortisone shots don’t damage the shoulder, 但对于大多数关节炎患者，大多数外科医生将其限制在每年不超过几次. 注射可的松可能会增加感染的风险，如果你在注射后不久接受了全肩关节置换术. 如果你正在考虑手术，请在手术前几个月避免注射可的松.

另一种治疗肩关节炎的药物是人工合成的 hyaluronic acid. It’s a naturally occurring lubricant in the human body. 这种液体物质多年来一直被注射到患有关节炎的膝盖上. 这种注射有时可以缓解长达两年的疼痛, 但要在很长一段时间内消除所有的痛苦是不寻常的.

目前的建议是在肩关节注射可的松后三个月内不要进行肩关节置换手术. If you are considering surgery, 在与医生讨论之前，最好避免注射可的松.

Shoulder Surgery

当非手术治疗不起作用时，你可能需要手术. 手术的选择取决于你的年龄和关节炎的程度.

Arthroscopic Shoulder Debridement

这种微创手术使用一个小相机(关节镜)和手术工具，通过小切口“清理”(清除)肩关节. 推荐用于关节炎等级较低的患者，当有骨对骨牵引时通常不推荐使用.

如果关节中还有软骨，有时清创可以缓解疼痛. No bone spurs are removed during this procedure, as the spurs are the result of arthritis and not the cause. 如果这个手术能缓解疼痛12到24个月，就被认为是成功的. Although in some cases the pain relief may last longer, 这种手术通常不是永久解决肩部关节炎的方法，因为它不能改变疾病的存在.

Shoulder Replacement

肩关节置换术是治疗骨对骨肩关节关节炎的首选方法. 它可以缓解关节炎的疼痛，并且已经被证明可以持续很多年.

A standard total shoulder replacement 将肩关节的球窝部分替换为人工部件.

In a reverse total shoulder replacement 程序中，将球和套筒两侧的接头调换位置. This procedure can be done for many conditions, 但它主要用于肩袖撕裂并伴有关节炎的情况.

现在还有其他类型的肩关节置换术没有被广泛使用. One such type is a hemiarthroplasty -一种只替换肩关节球部的手术. There is also an operation called a cup arthroplasty. It is similar to a hemiarthroplasty, 除了肱骨头(球)下的骨表面被移除. The area is smoothed and rounded, 一个形状像球的空心部分的替代物被放置在手臂骨的末端. 你的肩部专家会帮助你确定最好的治疗选择.