For once, somebody thinks I'm "too young" for something. Unfortunately, the problem is at age 42 I have severe shoulder pain from damage to the joint cartilage. Too young for a joint replacement and too old to keep playing mega sports with a painful arm. What are my options?
Young, active adults like yourself with shoulder problems may not want a shoulder replacement as the solution to their pain and loss of motion. And, at the same time, they may not be a good candidate for such a procedure. The surgeon's challenge is to find other ways to treat this problem called glenohumeral arthrosis.
The glenohumeral joint is what the lay person would call the shoulder joint. Arthrosis means damage has occurred to the joint surface. The first step in managing glenohumeral arthrosis requires a careful examination of the chondral (cartilage) surface and first layer of bone (the subchondral area).
The surgeon often uses X-rays and other more advanced imaging studies along with arthroscopic examination to find out what's going on inside the joint. There could be a rotator cuff tear, hole in the cartilage, or some abnormality of the surrounding soft tissue structures.
Conservative care is usually tried first for a good three to six months. The goal is to decrease pain and increase motion. Work and activity levels must be adjusted to protect the joint from further microtrauma. A physical therapist will guide patients through necessary lifestyle changes to accomplish this. At the same time, the therapist will prescribe an exercise program to improve strength, motion, and function.
Medications such as Tylenol, ibuprofen, and other nonsteroidal antiinflammatory drugs may be added to assist these nonoperative measures. Early reports support the use of hyaluronic acid injected into the joint. This treatment is used successfully for knee osteoarthritis and is being tried for patients with shoulder osteoarthritis.
When an adequate trial of conservative care fails to help, then surgery may be considered. There isn't one "best" treatment that works for everyone. The surgeon re-evaluates the patient in order to identify the best treatment approach. If you have not been evaluated by an orthopedic surgeon yet, an appointment for a consultation might be the next step.
The surgeon will take into consideration your individual factors such as age, activity level, goals, and job requirements. Disease-based factors are also reviewed and "weighed in" on the final decision. The surgeon takes into account the cause of the problem, the size of the chondral (cartilage) defects, and how deep the lesion goes.
For any size chondral lesion, the first line of surgical treatment is an arthroscopic examination and debridement. Debridement refers to surgically cleaning out the area of any debris and pieces of cartilage or other fragments in the joint space. The surgeon smoothes any rough sports and removes bone spurs.
If conservative care and/or debridement has been tried unsuccessfully with you, then surgery may be needed. There are other surgical procedures (e.g., joint resurfacing) available besides joint replacement. Your surgeon will advise you as to which one might serve you best.
Karen J.Boselli, MD. Treatment of Glenohumeral Arthrosis. In The American Journal of Sports Medicine. December 2010. Vol. 38. No. 12. Pp. 2558-2572.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.