Rheumatoid arthritis that affects the shoulder region is a progressive disorder that leads to pain, loss of range of motion and functional disability. The inflammatory response, which is of unknown cause, leads to synovitis (inflammation of the membrane lining the shoulder joint) and joint destruction.

Shoulder arthritis requires prompt diagnosis and treatment to prevent loss of mobility. For most patients, anti-inflammatory drugs, the range of specific exercises and the protection of the shoulder joint are an adequate treatment.

Even when the patient's history and physical examination suggest rheumatoid involvement of the shoulder, laboratory evaluation and radiographic evaluation are often necessary to establish the diagnosis.

The shoulder is very flexible, ensuring the high-amplitude movements of the arms, which it orients in all directions. The shoulder thus allows most of the gestures in everyday life, such as: eating, writing, washing etc.

The shoulder is the most mobile joint of the body, but also the most unstable. The joint is similar to a ball that is fixed in a cavity (glenoid cavity). This configuration allows a very high amplitude of movement, unprecedented in any other joint, but, at the same time, a smaller stability of it.

Otherwise, keeping the shoulder mobility and its stability are very important.

The component bones of the shoulder joint are:

➢ The humerus (it is the long arm bone)

➢ The scapula or shoulder blade, is a flat triangular bone, located in the posterior part of the shoulder.
The upper part of the scapula is formed by the acromion bone

➢ The clavicle (is a long bone that connects the scapula to the sternum).

The pattern of destruction of the rheumatoid shoulder is characterized by progressive damage to the joint and soft tissues. Basically, the involvement of soft tissues (joint capsule, ligaments, tendons etc.) determines the course/evolution of joint damage.

Drug treatment with painkillers and anti-inflammatories helps control pain and inflammation. But there are also antirheumatic disease-modifying drugs (DMARDs), also called non-biological therapy, as well as biological therapies, corticosteroids etc. The rheumatologist will decide the form of treatment depending on the evolution of the disease and its implications. Intraarticular corticosteroid therapy can be a useful adjuvant treatment, provided that the infection (not inflammation) has been ruled out.

Physical exercises, performed 4-5 times/day, are important for the recovery of movement in the rheumatoid shoulder, especially its rotation and elevation (lifting). The range of exercises must be assisted (helped) passively or actively. More precisely, if the shoulder is sensitive, practice exercises from the supine position with the help of a cane /stick guided by the healthy arm.

When there is a painful attack of arthritis, active antigravitational lifting of the affected arm should be avoided.

The exercises will initially target the weaker muscle groups, which are usually the flexors of the shoulder (raising the arm in front), adductors (raising the arm to the side) and external rotators (shoulder rotation).

As the pain subsides, active and later resistive exercises are added.

It is indicated in patients with significant pain and functional limitation.

The objectives of surgery are to relieve pain, increase mobility (movement) and restore shoulder function.

Surgery should be performed early in the course of the disease, thereby determining the long-term prognosis.

Depending on the pattern of destruction of the rheumatoid shoulder, surgical options can be early or late procedures.

Thus, joint preservation surgery is indicated in the early stages of joint destruction while the late stages of destruction require reconstructive surgery.