THE CLINICAL SYNDROME

• Shoulder arthritis can be caused by a number of conditions, one of which is damage to the cartilage that lines the joint.

• This makes the shoulder joint susceptible to developing arthritis.

• The most common reason for shoulder pain and functional disability is osteoarthritis.

• It is possible for it to happen as a result of a seemingly minor trauma or as a consequence of repeated microtrauma.

SIGNS AND SYMPTOMS

• The majority of patients who present to their doctor complaining of shoulder pain due to osteoarthritis, rotator cuff arthropathy, or posttraumatic arthritis describe their pain as being localized around the shoulder and upper arm.

• The pain is made significantly worse by activity, whereas resting and applying heat offers some relief.

• The pain is consistent and has been described as an aching sensation; it may prevent one from sleeping. On physical examination, crepitus may be present in some patients, and some patients report that using the joint causes them to experience a grating or popping sensation.

• Patients who suffer from arthritis of the shoulder joint frequently experience a gradual reduction in functional ability as a result of a decreasing shoulder range of motion. This is in addition to the patient's experience of pain.

• Because of this change, it is now significantly more challenging to perform routine activities such as brushing one's hair, putting on a bra, or reaching above one's head.

• Muscle atrophy and the development of a frozen shoulder are both potential outcomes of prolonged periods of inactivity.

TESTING

• Radiographs in the plain format should be taken of every patient who comes in complaining of shoulder pain.

• The clinical presentation of the patient may suggest the need for additional testing, which may include an evaluation of the patient's complete blood count, erythrocyte sedimentation rate, and antinuclear antibody levels.

• The use of computed tomography could aid in the diagnosis of skeletal abnormalities.

• If a rotator cuff tear or another soft tissue pathology is suspected in the shoulder, imaging tests using magnetic resonance and ultrasound should be performed on the shoulder.

• If there is a possibility of metastatic disease or a primary tumor involving the shoulder, then radionuclide bone scanning is something that should be done.

DIFFERENTIAL DIAGNOSIS

• However, rheumatoid arthritis, posttraumatic arthritis, and rotator cuff arthropathy are also common causes of shoulder pain.

• Shoulder pain is most commonly caused by osteoarthritis of the joint, which is the most common form of arthritis that results in shoulder pain.

• Shoulder pain that is caused by arthritis can also be caused by collagen vascular diseases, infections, villonodular synovitis, and Lyme disease, although these are less common causes.

• Acute infectious arthritis is typically accompanied by significant systemic symptoms, such as fever and malaise, and it should be easy to recognize; the condition is diagnosed through culture and treated with antibiotics rather than injection therapy.

• Shoulder pain that is caused by collagen vascular disease responds exceptionally well to the intraarticular injection technique that is described in this article.

• However, collagen vascular diseases typically manifest as a polyarthropathy rather than a monoarthropathy that is limited to the shoulder joint.

TREATMENT

• The initial treatment for the pain and functional disability associated with osteoarthritis of the shoulder is a combination of physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase-2 (COX-2) inhibitors.

• Both of these types of medications are anti-inflammatory medications.

• The application of heat and cold to specific areas of the body may also be beneficial.

• Patients who do not respond to these treatment modalities may benefit from an intraarticular injection of a local anesthetic and steroid as the next logical step in the treatment process.

COMPLICATIONS AND PITFALLS

• If the clinically relevant anatomy is carefully considered before administering the injection, this method does not pose a safety risk.

• In order to prevent infection, sterile technique must be utilized, and universal precautions must be taken in order to lessen the likelihood that the operator will be put in harm's way.

• If pressure is applied to the injection site immediately after the injection, this can help reduce the risk of complications such as ecchymosis and hematoma formation.

• Infection is the most significant risk associated with intraarticular injections into the shoulder joint; however, if proper aseptic procedure is followed, the risk of infection should be extremely low.

• Patients should be made aware of the possibility that they will experience a temporary increase in pain after receiving an intraarticular injection into the shoulder joint, as this affects approximately one quarter of all patients.