Arthritis Q&A

Ask the Consultant

Two of our leading orthopaedic specialists answer common questions on arthritis including signs and symptoms, preventative measures and effective treatments.

Malin Wijeratna

Arthritis is a disease causing painful inflammation and stiffness in a joint.

There are many different types as outlined below:

Osteoarthritis – Generally thought to be caused by ‘wear and tear’. The protective joint surfaces become damaged which leads to pain and stiffness.

Rotator cuff arthropathy – The torn shoulder tendons can no longer hold the ball (humerus) in the socket (glenoid) so the ball can move upwards and rub against other bones in the shoulder, causing pain.

Rheumatoid arthritis - The immune system attacks the linings of a joint, causing inflammation and pain.

Post-traumatic arthritis – A form of osteoarthritis that occurs after a joint has been damaged during a previous injury.

Avascular necrosis – A condition where the blood supply to bone is disrupted, which causes the bone to die and leads to destruction of the joint.

There are many different types of arthritis and they have different causes, but the symptoms are largely similar. 

Sudhir Rao
Arthritis is a condition that affects joints due to damage of the normal cushioning (articular cartilage) of the joint surface. This can be due to injury, infection, inflammation or other conditions. 

Malin Wijeratna

There are two joints in the shoulder, and both may be affected by arthritis. One joint is located where the clavicle meets the tip of the shoulder blade (acromion). This is called the acromioclavicular (AC) joint. The other joint is the ball and socket joint of the shoulder and is called the glenohumeral joint.

Pain and stiffness are the two most common symptoms of arthritis and the pattern of these symptoms in the two joints differ. Pain from the AC joint is typically felt at the top of the shoulder and can radiate to the neck. It tends to affect patients when they hold their arms overhead.

Pain from the glenohumeral joint is felt deep within the shoulder and can radiate down the side of the shoulder. As the joint stiffness progresses, patients have difficulty raising their arms overhead. 


Sudhir Rao
Joints can be painful, swollen, uncomfortable, stiffness, locking or giving way. 

Malin Wijeratna
Depending on the cause, arthritis can affect all age groups – from children to the elderly. Rheumatoid arthritis can affect people at an earlier age whilst osteoarthritis and rotator cuff arthropathy tends to affect older people. 


Sudhir Rao
Arthritis can affect anybody. It can occur by itself (idiopathic), run in families or secondary to joint damage by injury, inflammation, infection etc.

Malin Wijeratna
People can only reduce the risk of arthritis, not eliminate it. By maintaining a healthy weight and avoiding injury and repetitive movements, people can reduce the load on their joints. However, research suggests that there is a genetic element to most causes of arthritis and therefore you have a risk of developing arthritis if members of your family suffer from the disease.  


Sudhir Rao
Probably the best way to prevent arthritis is to avoid being overweight, take moderate exercise, reduce injury and take prompt treatment if the joint is damaged in any way. While I am not sure if any foods make a difference taking glucosamine/chondroitin, cod liver oil may help reduce symptoms. 

Malin Wijeratna

Non-surgical treatments for arthritis include simple measures such as over-the-counter painkillers and anti-inflammatory medication. Physiotherapy can also help to improve the range of motion of the joint and strengthen it.

If these methods fail to help, then more invasive measures such as steroid injections into the joint can help relieve the symptoms. However, as arthritis is a progressive disease the benefit of medication and physiotherapy can be temporary.

As a last resort, surgery should be discussed. Shoulder arthroscopy can be useful in early glenohumeral arthritis to clean out the joint and reduce the stiffness. In later stages of the disease, the shoulder joint can be replaced (arthroplasty).

A hemiarthroplasty only replaces the ‘ball’ of the ‘ball and socket’. A total shoulder arthroplasty replaces both the ‘ball’ and ‘socket’ with a metal ball and a plastic socket. In a reverse shoulder arthroplasty, the metal ball and plastic socket are attached to the opposite surfaces compared to a total shoulder arthroplasty. A reverse shoulder arthroplasty works better for people with cuff tear arthropathy because it relies on different muscles, not the rotator cuff, to move the arm.


Sudhir Rao
Arthritis treatment is generally conservative with correct advice on lifestyle, exercise, supplements and diet. Surgical treatment may be necessary for acute joint damage and pain due to arthritis. If symptoms are not controlled with conservative treatment then joint replacement can give considerable relief of pain and improve quality of life.  

Malin Wijeratna
The aim of all treatments for arthritis is to ease the pain from the joint and reduce the stiffness of the joint. If this can be managed with non-surgical treatments, then great! If not, then surgical management will need to be considered. 


Sudhir Rao
The benefits are better quality of life. It includes relief of pain, better mobility and to keep up a better lifestyle and activity to a much older age. 

Malin Wijeratna

All medicines have side-effects. But many people don't feel the side-effects, or they are able to deal with them. Patients should check that their usual tablets do not interact with the medication that they take for arthritis.

Intra-articular steroid injections have very little side-effects, however they do not last indefinitely and multiple injections may be necessary.

Surgical risks come with every operation and they differ for each person depending on the

person’s age, health, and the type of surgery performed. The risks of shoulder replacement

surgery are relatively low for major reconstruction of a joint. Potential risks include

infection, excessive blood loss, instability of the components (the ball will not stay in the

socket), nerve injury and blood clots.

Sudhir Rao
Any treatment carries risks. Generally conservative treatment carries low risk but tablets for reducing inflammation can itself be risky. Surgical treatment carries more risk and is reserved for acute pain or disabling pain and lack of mobility due to arthritis. 

Malin Wijeratna
Whilst In medical school I was attracted to orthopaedics because of the real benefits in quality of life it gave to patients. During my training I learned many techniques to treat different shoulder and elbow problems. I wanted to become a Consultant so that I could make a real difference for my patients and I am now being rewarded by the outcomes I am seeing in my patients due to the dedication, effort and sacrifices I made during my training.


Sudhir Rao
I wanted to be surgeon from the very early days of my medical career. I wanted to be able to help people to live healthy for longer with better lifestyle. This is what made me take up Orthopaedics as my speciality and being a Consultant help me offer my best skills to my patients. 

Malin Wijeratna
My interest in the treatment of arthritis led to me to complete a research project during my Fellowship in Melbourne, Australia where I looked at the results of a particular type of shoulder replacement. The highlight of my career was when my project was accepted for presentation at one of the most prestigious orthopaedic meetings in the world – the American Academy of Orthopaedic Surgeons. I have published a number of research papers on shoulder and elbow topics and I continue to seek out treatments that will help to deliver the best outcomes for my patients. 


Sudhir Rao
Becoming a Consultant is quite by itself an achievement. It involved over 10 years of training and then specialisation in Knee and Hip surgery. I am at the peak of my surgical skills and keep up to date with my field and am proud to offer the highest quality of care for my patients.

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