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Suggest treatment for severe pain in shoulders while having bilateral shoulder arthritis

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Posted on Thu, 2 Jun 2016
Question: Thank you, my husband has bilateral shoulder arthritis by xray. He has had severe pain in both shoulders, elbows wrists and hands. He had a cortisone injection into his shoulder joints which gave him some relief for 2 weeks. His is unable to move his arms above this elbow, hands look like baseball mitts, his grip is poor. his IM doc has prescribed pain RX whish has been minimally helpful. The ortho PA has suggested total shoulder surgery. What should be our next steps and what lab work should we request?
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Answered by Dr. Muhammad Hanif (7 hours later)
Brief Answer:
Medical management in a serial manner needs a try before going for surgery!

Detailed Answer:
I warmly welcome you here at HCM and assure you are at the best platform for the resolution of worrisome health issues of your husband.

I have carefully gone through the case in detail and can well realize your health worries. It is painful when it comes to the shoulder joint. Osteoarthritis causes joint deformity and pain due to inflammation and effusion (accumulation) of fluid inside the joint space.

I usually prefer a serial method of treatment in such a case. First of all we need to give a try to the medical management including Physical Therapy.

For your specific query to Labs needed:-
Plain radiographs of different angles and positions like Y-outlet, external rotation, PA and Axillary views are the ones that helps me diagnose the daily clinical cases of Glenohumeral Osteoarthritis OR simply the shoulder joint infection and pain. But many a times we also need to go for some specific diagnostics like CT Arthrography, MRI and Ultrasound of the joints.

If there is complete loss of movement and intractable pain then we may move to surgery. But if there is restricted range of movement as seen in your husband, we may go for a magical trick with NSAIDs, Physical therapy and injecting steroids serially inside the joint... Toning exercises; weighted pendulum and Passive stretch exercises, under the guidance of your local Physical Therapist will do the magic too.

Important:-
No pulling or pushing beyond the ability of the joint.
No overhead movement or trying to take the hands above the level of limit by the joint. This is important until normal looking tone is back in joint and muscles.

4 weeks NSAIDS course and maintenance afterwards with ACETAMINOPHEN 625 mg twice a day after meals.

Anterior side of the shoulder should be heated in moist heat/bathtub/warm shower (3 times a day for 15 min).

Injection of Steroid OR Sod.Hyaluronate inside the joint space is needed if there is no big relief after doing the above mentioned measures.

I usually go for a repeat 3 month radiography to see if there is any change in the disease process. Indicators for surgery can be:

Aggravating disease despite the above said measures.
Two to three injections inside the joint.
Time frame for medial measures being 6-12 months.

Keeping his age and the condition in mind, Prosthetic replacement can be the best surgical option, if any for your husband.

Postsurgical Physical therapy is the mandatory process and is very important to gain the benefits of the surgery. If his health doesn't allow him for that, I don't think it can be a good option to go for surgery.

If he has bone mineral density very low, then again it may be of no use to go for surgical replacement of the shoulder joint.

So, his orthopedist can well examine his deltoid and other muscles, rule out Frozen Shoulder disease and other causes for the pain and may well judge based on clinical evaluation if your husband is a good candidate for surgery.

Hope it helps your husband today. Please feel free to consult me anytime if you need further assistance on any health issue. You may also contact me directly at ( http://tinyurl.com/drhanifmd ) for a much faster reply.


Regards!
DR. HANIF
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Muhammad Hanif

General & Family Physician

Practicing since :2009

Answered : 2369 Questions

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Suggest treatment for severe pain in shoulders while having bilateral shoulder arthritis

Brief Answer: Medical management in a serial manner needs a try before going for surgery! Detailed Answer: I warmly welcome you here at HCM and assure you are at the best platform for the resolution of worrisome health issues of your husband. I have carefully gone through the case in detail and can well realize your health worries. It is painful when it comes to the shoulder joint. Osteoarthritis causes joint deformity and pain due to inflammation and effusion (accumulation) of fluid inside the joint space. I usually prefer a serial method of treatment in such a case. First of all we need to give a try to the medical management including Physical Therapy. For your specific query to Labs needed:- Plain radiographs of different angles and positions like Y-outlet, external rotation, PA and Axillary views are the ones that helps me diagnose the daily clinical cases of Glenohumeral Osteoarthritis OR simply the shoulder joint infection and pain. But many a times we also need to go for some specific diagnostics like CT Arthrography, MRI and Ultrasound of the joints. If there is complete loss of movement and intractable pain then we may move to surgery. But if there is restricted range of movement as seen in your husband, we may go for a magical trick with NSAIDs, Physical therapy and injecting steroids serially inside the joint... Toning exercises; weighted pendulum and Passive stretch exercises, under the guidance of your local Physical Therapist will do the magic too. Important:- No pulling or pushing beyond the ability of the joint. No overhead movement or trying to take the hands above the level of limit by the joint. This is important until normal looking tone is back in joint and muscles. 4 weeks NSAIDS course and maintenance afterwards with ACETAMINOPHEN 625 mg twice a day after meals. Anterior side of the shoulder should be heated in moist heat/bathtub/warm shower (3 times a day for 15 min). Injection of Steroid OR Sod.Hyaluronate inside the joint space is needed if there is no big relief after doing the above mentioned measures. I usually go for a repeat 3 month radiography to see if there is any change in the disease process. Indicators for surgery can be: Aggravating disease despite the above said measures. Two to three injections inside the joint. Time frame for medial measures being 6-12 months. Keeping his age and the condition in mind, Prosthetic replacement can be the best surgical option, if any for your husband. Postsurgical Physical therapy is the mandatory process and is very important to gain the benefits of the surgery. If his health doesn't allow him for that, I don't think it can be a good option to go for surgery. If he has bone mineral density very low, then again it may be of no use to go for surgical replacement of the shoulder joint. So, his orthopedist can well examine his deltoid and other muscles, rule out Frozen Shoulder disease and other causes for the pain and may well judge based on clinical evaluation if your husband is a good candidate for surgery. Hope it helps your husband today. Please feel free to consult me anytime if you need further assistance on any health issue. You may also contact me directly at ( http://tinyurl.com/drhanifmd ) for a much faster reply. Regards! DR. HANIF