Protective cartilage covers the ends of the bones within the shoulder joint, providing a smooth surface for painless joint motion. When cartilage is injured, it can cause pain, inflammation, and physical limitations. Because cartilage has no blood supply, it cannot heal on its own. A crack or fissure can continue to progress until the cartilage wears down completely, resulting in arthritis with pain, stiffness, and other joint symptoms.
What Are Shoulder Cartilage Injuries?
Within the shoulder joint, protective cartilage covers the ends of the bones to provide a smooth surface for painless joint motion. The cartilage itself, however, is susceptible to injury.
Once injured, damaged cartilage can cause pain and inflammation in the shoulder joint, as well as physical limitations. Because cartilage has no blood supply, it cannot heal on its own. A simple crack or fissure can continue to progress until the cartilage wears down completely, resulting in arthritis.
Smaller, isolated cartilage tears may not cause significant symptoms, while larger, more complex tears are more likely to cause continued pain and other symptoms.
Causes and Risk Factors
Causes and risk factors for shoulder cartilage injuries include:
- A traumatic injury, such as a fall or blow to the shoulder
- Repetitive motion and overuse, such as exercising without moderation
- Compressive, shearing, or rotational force to the shoulder
- Contact or collision sports
- Concurrent joint injury
- Poor flexibility and physical conditioning
Symptoms
Signs and symptoms may include:
- Pain and swelling, especially following activity
- A feeling of something moving in the joint
- The joint “giving way,” catching, or locking
- A “crackling” sensation (crepitus) with motion
- Stiffness, especially following inactivity
- Symptoms associated with an injury that also damages other structures, such as tendons or ligaments
Diagnosis
Shoulder cartilage injuries may occur along with injuries to other structures, such as tendons or ligaments. The extent of the cartilage injury and associated shoulder damage helps guide treatment.
Treatment
Initial treatment consists of activity modification, including stopping aggravating activities, as well as rest, ice, and anti-inflammatory medications to relieve pain. Specific physical therapy programs may also be recommended to reduce pain and restore function.
When symptoms warrant, Dr. Chudik can perform arthroscopic surgery to address the cartilage injury. Using a small arthroscopic camera and tools, he smooths the damaged surfaces. Abrading or drilling the exposed bone surface can stimulate a healing response, allowing blood and marrow contents to escape from the bone and fill the articular cartilage defect.
Larger tears that do not respond as well to these techniques can be treated with more aggressive restorative cartilage procedures, although outcomes are variable. These procedures may include:
- Osteochondral Allograft/Autograft Transplantation (OATS): Cartilage and bone tissue are transplanted from another site or person into the injured area.
- Autologous Chondrocyte Implantation (ACI): Cartilage cells are harvested from the patient, grown in a lab, and then reinserted into the injury site.
Recovery and Outcomes
The recovery period and use of a sling depend on the extent of the cartilage tears or damage and the surgical procedure performed. Patients may need to wear a sling for up to six weeks. Physical therapy begins two to three days following surgery to restore shoulder range of motion while protecting the repaired portion of the shoulder. Recovery may require up to six months.
Smaller, isolated cartilage tears may not cause significant symptoms and may not require surgical intervention. Larger, more complex tears are more likely to cause continued pain and other symptoms and are typically addressed surgically. These injuries are also more likely to progress and lead to arthritis. Timely, appropriate treatment can help reduce symptoms and return the patient to moderate activity levels.
When to See Dr. Chudik
Consider an evaluation for persistent or worsening shoulder symptoms, including pain, swelling, stiffness, catching, locking, a feeling that something is moving within the joint, or a “crackling” sensation with motion.
Call 630-324-0402, request an appointment online, or email contactus@chudikmd.com.