Shoulder osteoarthritis. Diagnostics & Therapy

Important: To find the right therapy for the shoulder arthritis.

A shoulder osteoarthritis can be treated depending on the severity of joint wear conservative or during surgical care.

A shoulder osteoarthritis can be treated depending on the severity of joint wear conservative or during surgical care.

Many people suffer in their lives under the wear and tear of their joints - the so-called osteoarthritis. Also, the shoulder joint is often affected hereof. But not always an operation is necessary: In the early stage of osteoarthritis, conservative treatment measures such as physiotherapy, physical applications or muscle training can help to slow down the further progression or even avoid - and counteract pain.

In order to initiate appropriate therapy for osteoarthritis of the shoulder, a thorough diagnosis of the affected joint is first necessary. Depending on the nature and severity of joint wear, the attending physician will work with you to choose the right treatment.

 

Diagnostics & Therapy of arthritis of the shoulder at a glance.

Diagnostics. How is arthritis of the shoulder diagnosed?

X-ray helps determine the osteoarthritis.

Pronounced arthritis of the shoulder (omarthritis) with the head of the humerus elevated due to a torn tendon.

Pronounced arthritis of the shoulder (omarthritis) with the head of the humerus elevated due to a torn tendon.

The suspicion of shoulder arthritis based on clinical findings must be supported by diagnostic imaging. In most cases, x-rays of the joint from several different angles will be sufficient. The x-rays will show changes in the bone structures of the joint (bone spurs, rounding, thickening or cystic destruction in the bone, as well as defects around the edge of the socket or extreme bone damage). They will also detect narrowing of the joint space caused by the break-up of cartilage and indirect signs of soft tissue damage (elevated position of the head of the upper arm bone (humerus), twisting or in isolated cases, dislocation) to the front or back.

 

Magnetic resonance imaging, computed tomography, ultrasound.

MRI for instability to the front of the shoulder.

MRI for instability to the front of the shoulder.

Supplementing the testing with magnetic resonance imaging, which is necessary in most cases, may also provide some initial information on the extent of the damage to the bone. Furthermore, the soft tissue structures (rotator cuff, biceps tendon, capsule and synovial sac) must be inspected to look for defects, changes and abnormal inflammation. If further treatment is planned in the form of a shoulder replacement, computed tomography (a CT scan) is necessary in most cases to provide further images, which will show 'slices' of the shoulder. Magnetic resonance imaging or ultrasound may also be performed initially as basic diagnostic procedures in order to look for defects in the rotator cuff and associated inflammatory reactions.

 

Therapy. Treatment options for shoulder arthritis

Conservative treatment for arthritis of the shoulder.

Mobilising physical therapy may help in the early stages of arthritis.

Mobilising physical therapy may help in the early stages of arthritis.

In the early stages of shoulder arthritis, conservative local treatment may help initially. Such treatment would entail physical therapy to mobilise the joint, with pain relief achieved using pain medications or physical measures. Often, initial cooling (cryotherapy) with cold air or ice will prove beneficial. In these cases, attention also needs to be paid to muscular dysbalance, in other words, contraction of the muscle in certain locations or weakening of the shoulder muscles performing a centering function. Treatment should also improve any possible malalignment, particularly in the upper segments of the spine. Alternatively, an active process can be alleviated with a type of x-ray irradiation (x-ray stimulation therapy). Additional physical approaches might be attempted, including microwave, diadynamic current or ultrasound. The local therapy options for your doctor include infiltration of the shoulder joint capsule or upper joint space, or injection of pain relieving medications directly into the shoulder joint, in most cases together with a dose of cortisone. Pain-relieving anti-inflammatory medications are used to achieve general pain relief and reduce irritation.

 

Surgical treatment for arthritis of the shoulder.

Left: Short-shafted replacement humeral head. Right: Reverse shoulder replacement.

Left: Short-shafted replacement humeral head. Right: Reverse shoulder replacement.

If symptoms persist, further steps should be considered. If it is clear that the neighbouring joints in the shoulder girdle are causing changes and problems, correction of these joints is recommended: Enlargement of the gliding space or suture repair/reconstruction of the rotator cuff, as well as release or removal of parts of the shoulder joint. If there is instability or joint dislocation, it may in individual cases be possible to attempt to reseat and stabilise the shoulder joint. However, in cases of severe omarthritis (arthritis of the shoulder), an artificial joint may also be considered. The goal of this surgery is to achieve long-term pain relief and improve limited shoulder mobility to allow patients to cope with everyday demands.

 

The following options are available:

  • Shoulder resurfacing, in most cases without replacement of the socket – Advantage: preserves bone, Requirements: socket in good condition, preferably younger patient, good bone condition
  • Short-stem prosthesis with replacement of the socket – Advantage: preserves bone, better function over the long-term due to the replacement of the socket, Requirements: preferably younger patient, good bone condition
  • Humeral head replacement (with or without cement) - Requirements: no defects in the shaft of the humerus, socket in good condition, Advantage: simple implantation technique with few complications, Disadvantage: poorer function over the long term without replacement of the socket
  • Total shoulder replacement - Advantage: better shoulder function is to be expected, Requirements: it must be possible to implant the replacement socket, Disadvantage: possible short-term or longer-term risks associated with the artificial joint socket
  • Reverse shoulder replacement - the socket becomes the ball of the joint and the humeral head becomes a socket, resulting in improved strength development in the surrounding musculature of the shoulder, Advantage: improved active mobility, higher degree of stability with regard to dislocation, Disadvantage: higher risk of the head components coming loose and of infection, therefore only in patients over 68 - 70 years old with extensive tendon damage, chronic instability and major bone damage, as well as for the replacement of existing prostheses
  • Last-resort shoulder replacement with large head - after removal of or primary defect in the rotator cuff, a large head can be placed on the shaft of the humerus to permit it to rest against the bony roof of the shoulder.  
 

Shoulder osteoarthritis

This disease involves damage in the joint between the shoulder socket and the head of the upper arm bone.

Joint wear and tear in the shoulder

Specialised clinics

Our specialized clinics & hospitals for diagnostics, treatment & therapy of arthritis of the shoulder and omarthrosis at a glance.

Specialised clinics