SHOULDER OSTEOARTHRITIS
Shoulder osteoarthritis
Shoulder osteoarthritis, also known as glenohumeral osteoarthritis, is a common degenerative condition of the shoulder joint. It arises when the cartilage that cushions the joint and reduces the friction between the bones wears away over time. This leads to painful inflammation, restricted movement and, at an advanced stage, to a markedly reduced function of the shoulder joint.
Causes of shoulder osteoarthritis
How does osteoarthritis develop in the shoulder?
The causes of shoulder osteoarthritis are varied and can include both age-related changes and injuries.
- Age-related wear: with increasing age the cartilage loses its elasticity and firmness, which leads to slowly progressing wear. Shoulder osteoarthritis is therefore widespread in older people.
- Injuries: an earlier fracture of the upper arm bone (humerus) or of the shoulder socket (glenoid) can increase the risk of osteoarthritis. Extensive inflammation or an injury to the rotator cuff can also lead to osteoarthritis in the long term.
- Deformity and instability: congenital or acquired deformities of the shoulder, such as a dislocation or dysplasia (a malformation of the joint), can increase the risk of osteoarthritis, because they distribute the load on the joint unevenly.
- Overloading: repeated, intensive loading of the shoulder joint, as occurs in certain occupations or sports, can lead to premature wear of the cartilage.
Symptoms
The symptoms of shoulder osteoarthritis generally develop gradually and can change over time with the severity of the condition. The most common signs are pain, restricted movement and stiff joints.
Pain
At the beginning of the condition pain occurs above all when moving the arm, particularly with activities above the head. Later, pain at rest can occur as well, above all at night.
Restricted movement
Over time the shoulder becomes less mobile, which makes raising the arm or rotating the wrist harder.
Noises
As the osteoarthritis progresses, grinding or clicking noises can occur in the joint when the bones rub against each other.
Diagnostics
Shoulder osteoarthritis is diagnosed in several steps, comprising both a thorough clinical examination and imaging, in order to assess the severity of the condition and arrive at a precise diagnosis.
Clinical examination
To begin with, the doctor takes a detailed history in order to learn more about the symptoms and the patient's medical background. Questions cover the symptoms in particular: how severe the pain is, the range of movement and any earlier injuries to the shoulder. A physical examination follows, in which the doctor tests the movement of the shoulder and looks for the typical signs of shoulder osteoarthritis such as pain, stiffness and restricted movement.
- Provoking the pain: the doctor may carry out particular movements to find out which movements or activities cause pain. This can help to narrow down the affected areas of the joint.
- Palpation: by feeling the shoulder, the doctor can identify inflammation or other findings that point to osteoarthritis.
X-ray
X-rays are an indispensable diagnostic tool for showing structural changes in the shoulder joint, such as narrowing of the joint space, the formation of osteophytes (bony outgrowths) and cyst formation in the bone, all of which are typical signs of progressing osteoarthritis.
MRI (magnetic resonance imaging)
MRI is a further step, used particularly in complicated cases. While X-rays mainly show the structure of the bone, MRI provides detailed images of cartilage, ligaments and soft tissue. It helps to assess the condition of the cartilage and to identify early signs of osteoarthritis that may not be visible on X-rays.
Ultrasound
Ultrasound can be used alongside MRI to identify inflammation or fluid in the joint. It is a non-invasive method, generally used to support the diagnosis in patients with mild to moderate symptoms. It can also help to show damage to the tendons or calcification in the shoulder.
Arthroscopy
In very rare cases, where the diagnosis is unclear or other treatments have not been successful, an arthroscopy can be carried out. A small camera is introduced into the shoulder through a tiny incision in order to examine the joint from the inside. This method gives precise information about the state of the joint and about any damage.
Treatment options
Shoulder osteoarthritis is a degenerative joint condition that can lead to progressive pain, stiffness and restricted movement. Its treatment depends on the severity of the condition, on the age and activity level of the patient and on individual needs.
The aim of treatment is to relieve the pain, improve movement and preserve the patient's quality of life. Treatment can be non-surgical or surgical, and the decision about the appropriate method is taken according to the patient's particular circumstances.
Non-surgical treatment: with mild to moderate symptoms, non-surgical treatment can be successful.
Surgical treatment: for advanced osteoarthritis, or where non-surgical measures are not sufficient.
Treatment options
Non-surgical and surgical – we will find the right approach for you
Medication
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac or naproxen are frequently used to relieve pain and inflammation.
Physiotherapy
Physiotherapy has a key role in the treatment of shoulder osteoarthritis, because it works specifically to strengthen the muscles and encourage movement. A combination of strengthening and stretching exercises, manual therapy and ergonomic advice not only reduces the load on the joint but also improves what the shoulder can cope with day to day in the long term.
Hyaluronic acid injections
These injections are used to replace the fluid in the joint and improve movement. They act as a lubricant and can help to preserve the function of the joint, particularly in the early stages of osteoarthritis.
PRP (platelet-rich plasma) injections
PRP injections are a relatively new method in which blood is taken from the patient, prepared in a special process and then injected into the shoulder joint. The PRP contains growth factors that can support the healing of tissue and reduce inflammation.
Arthroscopic surgery
In the early or middle stages of shoulder osteoarthritis, an arthroscopic operation can help to improve the state of the joint. In this minimally invasive technique a small camera (an arthroscope) is introduced into the joint in order to remove damaged parts of the cartilage or to repair damage.
Hemiarthroplasty (partial replacement)
Unlike a total or a reverse shoulder replacement, a hemiarthroplasty replaces only part of the shoulder joint, typically just the head of the upper arm bone (humerus). The shoulder socket is left intact.
Anatomical total shoulder replacement
The anatomical shoulder replacement is the most common form of joint replacement for shoulder osteoarthritis and resembles the natural structure of the joint. It is used where both the head of the upper arm bone (humerus) and the shoulder socket (glenoid) are badly damaged by the osteoarthritis.
Reverse shoulder replacement
The reverse shoulder replacement is a special form of joint replacement in which the normal anatomy of the shoulder joint is inverted. The construction of the joint is altered so that the function of the shoulder is preserved even without an intact rotator cuff.
Aftercare
Aftercare has a decisive role in healing and in restoring the function of the shoulder after shoulder osteoarthritis has been diagnosed and treated. It aims to relieve pain, improve movement and keep the shoulder stable and functional in the long term. It comprises both non-surgical measures and, where an operation has been carried out, specific rehabilitation.
Consistent aftercare and avoiding overloading during the healing phase are particularly important.
Outlook
The outlook with shoulder osteoarthritis varies with the stage of the condition and the type of treatment. In the early and middle stages a good relief of symptoms is possible, and the movement of the joint can largely be preserved.
In advanced cases, replacing the joint with a shoulder prosthesis offers an excellent way of restoring joint function and relieving pain. After an operation, too, patients can generally expect a marked improvement in their quality of life, with long-term aftercare and rehabilitation playing a key role.
Frequently asked questions about shoulder osteoarthritis
Here you will find answers to the questions most often asked about shoulder osteoarthritis and its treatment.
What is shoulder osteoarthritis?
What are the main causes of shoulder osteoarthritis?
Which symptoms point to shoulder osteoarthritis?
How is shoulder osteoarthritis diagnosed?
Can shoulder osteoarthritis be cured?
How is shoulder osteoarthritis treated?
What role does physiotherapy play in treating shoulder osteoarthritis?
When is an operation necessary?
How can I prevent shoulder osteoarthritis?
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