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Arthritis - Tyler Welch, MD
York, ME (207) 363 3490 | Portsmouth, NH (603) 431 1121

20Hip Care
10Hip-Conditions and Injuries
Cartilage Injury
Femoroacetabular Impingement (FAI)
Gluteal Tears
Hamstring Tears
Hip Instability
Deep Gluteal Space Syndrome
Labral Tears
Psoas Impingement (Internal Snapping Hip)
PVNS
Trochanteric Bursitis
10Hip-Treatment and Surgeries
Acetabuloplasty
Chondroplasty
Femoroplasty
Gluteal Repair
Labral Debridement
Labral Reconstruction
Labral Repair
Nanofracture
Psoas Release
Trochanteric Bursa Debridement
33Knee Care
13Knee Conditions and Injuries
ACL Tear
Cartilage Injury
Discoid Meniscus
Lateral Meniscus Tear
LCL Injury
MCL Injury
Medial Meniscus Tear
Osteoarthritis
Osteochondritis Dessicans
Patellar Instability
Patellofemoral Chondromalacia
Posterolateral Corner Injury
Trochlear Dysplasia
20Knee Treatment and Surgeries
Anterior Cruciate Ligament (ACL) Reconstruction
Cartilage Restoration Surgery – Autologous Chondrocyte Implantation (ACI-Carticel)
Cartilage Restoration Surgery – Donor Graft
Collagen Meniscal Implant (CMI)
Lateral Collateral Ligament (LCL) Reconstruction
Medial Collateral Ligament (MCL) Reconstruction
Meniscus Repair
Meniscus Root Repair
Meniscal Transplant
Medial Patellofemoral Ligament (MPFL) Reconstruction
Nanofracture
Osteochondral Allograft Transfer
Osteochondral Autograft Transfer (OATS)
Partial Knee Replacement (MAKO)
Partial Meniscectomy
Posterior Cruciate Ligament (PCL) Reconstruction
Posterolateral Corner (PLC) Surgery
Tibial Tubercle Osteotomy
Total Knee Replacement (MAKO)
Trochleoplasty
20Shoulder Care
10Shoulder-Conditions and Injuries
AC Joint Injuries
Arthritis
Biceps Tendon Injuries
Calcific Tendinitis
Clavicle Fractures
Frozen Shoulder
Labral and SLAP Tears
Rotator Cuff Injuries
Shoulder Dislocation/Instability
Subacromial Impingement/Busitis
10Shoulder-Treatment and Surgeries
A-C Joint Stabilization
Biceps Tenodesis
Clavicle Fracture Fixation
Pectoralis Major Repair
Rotator Cuff Repair
Shoulder Instability Surgery – Bankart Repair
Shoulder Instability Surgery – Latarjet Procedure
Subacromial Decompression and Acromioplasty
Superior Capsular Reconstruction
Total Shoulder Replacement

ARTHRITIS

 Just like other joints in the human body, the shoulder joint is made up of bones (the humerus and glenoid) that are lined by cartilage. Cartilage is a very smooth, soft substance that allows the humerus (ball) to move smoothly and glide along the socket (glenoid). Arthritis occurs when cartilage wears down so that the bony ends of the shoulder joint become exposed. Unlike cartilage, bone has free nerve endings and does not have a smooth surface. As a result, when the bone is exposed, movement in the shoulder can cause catching and other symptoms, because the cartilage is no longer protecting the bone.

There are many different causes of arthritis. The most common cause is osteoarthritis. Osteoarthritis occurs when the cartilage breaks down over time due to wear and tear. There is also a genetic component to osteoarthritis, and some patients may be predisposed to developing arthritis based on family history. Other causes of arthritis in the shoulder include inflammatory arthritis, such as rheumatoid arthritis. This type of arthritis usually involves irritation of the lining of the shoulder (capsule and synovium) in addition to cartilage damage. A third type of arthritis is post-traumatic arthritis. This type of arthritis occurs when cartilage is damaged following a fracture or dislocation in the shoulder joint. Over time, the injured cartilage and surrounding cartilage in the shoulder may break down further – leading to a condition similar to osteoarthritis.

Symptoms

  • Intermittent pain, aggravated by activity
  • Catching and grinding, particularly with overhead or rotatory motion
  • Stiffness

Diagnosis And Treatment

Dr. Welch considers each patient’s symptoms, as well as a detailed physical examination and x-rays to make the diagnosis of shoulder arthritis. There are many different treatment options for arthritis. Oral analgesics or anti-inflammatories, such as Tylenol or Motrin, can help relieve the symptoms, especially when one has a “flare-up” of the arthritis. Intermittent icing and limiting overhead and rotatory motion in the shoulder may also help lead to improvement in symptoms. Physical therapy is another option. A dedicated physical therapy program that promotes shoulder motion and appropriate mechanics of the shoulder may relieve certain symptoms.

Another treatment option for shoulder arthritis is injections. There are many different types of injections, including steroid injections, platelet-rich-plasma (PRP), stem cells, and visco-supplementation. When performing an injection, Dr. Welch prefers to use ultrasound for guidance. Dr. Welch can visualize the injection going into the right spot in the shoulder when using an ultrasound machine. A steroid is an anti-inflammatory medication that can help reduce the irritation in the shoulder. Visco-supplementation is a lubricating fluid that may also help reduce the irritation in the shoulder joint. Although the data supporting PRP and stem cells is limited, these injections can also reduce the inflammation in the shoulder joint, potentially leading to less pain.

In those patients who do not improve with non-surgical treatment, Dr. Welch may recommend surgery. Some patients can benefit from minimally invasive, arthroscopic surgery. This surgery is a viable option for young, active patients with arthritis who wish to avoid a shoulder replacement surgery.

When arthritis becomes severe, Dr. Welch usually recommends shoulder replacement surgery. There are several different types of shoulder replacement surgery, including a total shoulder replacement, partial shoulder replacement (hemiarthroplasty), or reverse shoulder replacement. In both a total shoulder replacement and reverse shoulder replacement, the ball and socket are replaced. In a partial shoulder replacement, only the ball is replaced with a metal prosthesis.


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