Rheumatoid arthritis of the shoulder
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What is it?
In rheumatoid arthritis, the synovium which lines joints and tendons becomes swollen and inflamed. In some individuals, the disease progresses with destruction of joint cartilage and tendon rupture. Pain, stiffness, loss of movement and deformity of the joint may follow.
What is it?
How is it diagnosed?
Rheumatoid arthritis of the shoulder is diagnosed on the basis of the history as described above, and by clinical examination. This may include special blood tests or the taking of tissue samples (biopsy). In order to plan orthopaedic treatment it may be necessary to take plain radiographs and/or scans (ultrasound, CT and MRI).
What is my approach to treatment?
It is important that an assessment is carried out by a rheumatologist, as there are now highly effective treatments available that may limit the process of joint destruction and tendon rupture. If these medical measures fail to achieve symptom control then removing synovium using keyhole surgery (arthroscopic synovectomy) may be beneficial. Shoulder joint replacement is normally carried out at an earlier stage of joint destruction than osteoarthritis, as the process often affects the rotator cuff tendons and this can limit the choice of joint implant. You can ask for more details at your first consultation.
What does an operation involve?
Surgery is normally carried out under general anaesthetic, often supplemented with regional anaesthetic. A laminar flow theatre is used in order to minimise the risk of infection. An inpatient hospital stay of 2 to 3 nights is recommended. An incision is made either to the front or side of the shoulder, depending on the implant to be used. The worn joint surface is removed using special instruments and the remaining bone is shaped to accept the implants, made of metal or plastic. These implants are either cemented into place or have an artificial coating onto which the bone grows. The area is washed with saline and the wound is closed in layers. The skin is closed with non-absorbable sutures or clips. These are removed in the clinic after two weeks.
What is the recovery period?
The arm rests in a sling until 72 hours when controlled shoulder movements begin under supervision of the physiotherapist. This continues for several months. The exact regimen may vary as it will depend on numerous factors. Driving is usually possible after 6 to 8 weeks. When a patient is ready to return to work depends on their specific job role and may also vary from individual to individual. It may be possible to return to light keyboard work after six weeks. Heavy manual work and all loading, lifting, pushing and pulling including sports must be discontinued or the joint replacement will loosen.
Are there any possible complications?
Over 90% of patients are satisfied with the pain relief achieved. However, as with any treatment, there are always risks involved: Infection: 2%, Frozen shoulder: 5%, Nerve injury: 2%, Intraoperative fracture: 1%, Dislocation: Variable. The loosening rate for shoulder implants is about 10% after 10 years. This may require further complicated surgery. You can ask for more details at your first consultation.
