Orthopedics-Online

Osteoarthritis in the shoulder

Synonyms

Omarthrosis
Osteoarthritis of the shoulder

introduction

Osteoarthritis of the shoulder is an irreversible wear and tear of the cartilage in the shoulder joint.
The main bony shoulder joint (Latin glenohumeral joint) consists of the humerus head (lat. Humeral head) and the shoulder socket as part of the shoulder blade (Latin glenoid). The shoulder joint (lat. Acromioclavicular joint) consisting of shoulder height (Latin Acromion) and collarbone (lat.clavicula), is in the immediate vicinity and, like all joints, can be affected by arthritic changes.
Due to the lower stress, osteoarthritis occurs less frequently in the shoulder joint than in the hip or knees.

The shoulder joint is primarily dependent on guidance from muscles and tendons. Injuries at these levels are more common than osteoarthritis and should therefore be taken into account if there are complaints in the shoulder area. Examples of this and not to be equated with osteoarthritis of the shoulder are the calcareous shoulder (tendinosis calcarea), the impingement syndrome or injuries to the rotator cuff.

Symptoms

The symptoms of osteoarthritis in the shoulder are unspecific and can hardly be distinguished from other shoulder diseases.
Diffuse pain in the shoulder radiating to the upper arm or towards the shoulder blade as well as restricted mobility can be signs of osteoarthritis. These complaints can increase under increased stress, especially when turning the arm (e.g. cleaning windows) and working overhead. Lying on the affected side can be painful, and everyday movements such as tying your apron and combing your hair can become unbearable.

Increased pain when lifting to the side would rather suggest an impingement syndrome (bursa / tendon entrapment under the shoulder roof).

Due to the soft tissue covering made up of muscles (rotator cuff) and skin, which is usually well covered, swelling of the shoulder joint (e.g. due to an inflammation of the mucous membrane) in connection with osteoarthritis of the shoulder is usually not seen.

Learn more about: Symptoms of shoulder arthrosis

causes

As with all forms of osteoarthritis, it is important to distinguish between primary and secondary osteoarthritis of the shoulder. With primary osteoarthritis (shoulder arthrosis) no cause can be found.

Certain activities like:

Swimming competitions
play the violin
Painting work
Overhead work etc.

lead to mechanical stress on the shoulder joint when exercised frequently and can increase the risk of osteoarthritis in the shoulder.

Possible causes of secondary osteoarthritis of the shoulder are damage to the rotator cuff, usually injury or degenerative changes in the supraspinatus tendon. The muscular imbalance leads to incorrect loading with subsequent cartilage abrasion and after a while.

Other causes of osteoarthritis of the shoulder can be:

Shoulder dislocations (shoulder dislocations)
Fractures / broken bones that reach into the joint space
previous operations on the shoulder joint
and
Infections of the shoulder joint

are other possible causes for the development of omarthrosis.

Appointment with a shoulder specialist

I would be happy to advise you!

Who am I?
My name is Carmen Heinz. I am a specialist in orthopedics and trauma surgery in the specialist team of .

The shoulder joint is one of the most complicated joints in the human body.

The treatment of the shoulder (rotator cuff, impingement syndrome, calcified shoulder (tendinosis calcarea, biceps tendon, etc.) therefore requires a lot of experience.
I treat a wide variety of shoulder diseases in a conservative way.
The aim of any therapy is treatment with full recovery without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

Lumedis - your orthopedic surgeon
Kaiserstrasse 14
60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
You can find more information about myself at Carmen Heinz.

diagnosis

A description of the symptoms mentioned above and references to specific causes of osteoarthritis in the shoulder (see above) help to establish the diagnosis. In addition to the physical examination to differentiate the symptoms, an X-ray examination is crucial.

On the x-ray there are changes typical of osteoarthritis such as:

Joint space narrowing
increased white drawing of the joint surfaces (sclerotherapy)
Cysts in the bone (rubble cysts)
and
bony attachments (osteophytes)

to recognize.
An MRI examination can be performed to confirm involvement of the tendon group around the shoulder joint (rotator cuff).

This is particularly important when deciding on a shoulder prosthesis, as the model is chosen according to the tendon relationships.

Read more on the topic: MRI of the shoulder joint.

The therapy options

As with symptoms of arthritic changes in other joints, osteoarthritis of the shoulder should initially begin conservatively.

Depending on how you feel, cooling the shoulder (cryotherapy), but also keeping the joint warm, can provide relief. Targeted muscle building and other physiotherapeutic measures are important in order to compensate for an incorrect load. This can slow down the progression of osteoarthritis and alleviate the symptoms. In addition, a suitable diet can alleviate the symptoms of osteoarthritis to some extent.

Correction of possible bad posture in the upper sections of the spine can also support the healing process. In some cases, X-ray stimulation can prevent the osteoarthritis from progressing in the shoulder.

Medicines such as ibuprofen, Voltaren or Arcoxia can be used for further pain therapy.
During inflammatory phases, a cortisone preparation injected directly into the shoulder can alleviate the symptoms. Hyaluronic acid can be injected into the joint space to maintain and improve the quality of the cartilage.
If the conservative methods do not sufficiently relieve the patient, a decision can be made about surgical therapy.

In the case of advanced shoulder osteoarthritis, surgical therapy can be useful. The sliding space in the shoulder can be expanded, for example, the shoulder muscles (so-called rotator cuff) can be reconstructed. Relief or removal of parts of the shoulder joint can also be carried out.
In the case of very pronounced osteoarthritis of the shoulder, an artificial joint replacement should be considered in order to treat the pain in the long term and to improve the limited mobility of the shoulder. There are different shoulder joint prostheses (e.g.Cap prosthesis, humeral head prosthesis, total shoulder prosthesis, inverse shoulder prosthesis), which can be used in advanced osteoarthritis.

Depending on the severity of the osteoarthritis, simple cleaning of the shoulder joint (debridement) using arthroscopy may be sufficient.

Learn more about: Arthroscopy of the shoulder

Hyaluronic acid

Since osteoarthritis of the shoulder causes wear and tear of the joint cartilage, the joint partners involved cannot slide well. This causes pain.
The hyaluronic acid is supposed to improve this lack of lubricity and protect the remaining cartilage from further wear. For this, the hyaluronic acid is injected directly into the joint.

There is no new formation of cartilage, so the injection of hyaluronic acid into the shoulder joint only has a temporary effect and must be repeated at certain intervals.

Find out more about the topic here: Hyaluronic acid used to treat joint diseases.

homeopathy

Homeopathic remedies can be used to support drug therapy or physiotherapy. The intake of globules can thus help to alleviate the symptoms of shoulder osteoarthritis.
For example, 5 globules of Harpagophytum procumbens can be taken three times a day to prevent joint swelling and pain. If the joints are rather stiff and movement is restricted, Hedera helix or Hekla lava can help to improve the symptoms. Bryonia or Symphytikum can also be taken in the shoulder for osteoarthritis.

Read more on the topic: Homeopathy for osteoarthritis

Osteopathy

Osteopathy can also help relieve the symptoms of osteoarthritis in the shoulder and slow the progression of the disease. Movement restrictions that exist due to osteoarthritis can also be improved.

The concept of osteopathy is that the body is stimulated to heal itself by manipulating and mobilizing the joint and relaxing muscles. The treatments often have to be carried out over weeks to months, as one treatment is usually not sufficient.

Find out more about the topic here: Osteopathy.

Who can shoulder surgery help?

Whether an operation is beneficial for osteoarthritis of the shoulder must be decided on an individual basis. A distinction is made between smaller interventions, in which, for example, the joint cartilage is smoothed or inflamed tissue is removed, and large interventions in which parts of the joint or the entire joint are replaced.

An operation is considered in patients who have not achieved pain relief through physiotherapy or medicinal measures and the patient feels that his quality of life is severely restricted because movements can no longer be performed or the pain increases at rest or at night are felt.
In younger patients in particular, it is important to improve movement and be free from pain. For older people and those suffering from many diseases (Latin polymorbid) Patients, the surgical risks must always be lower than the benefits and treatment success.

Whether an operation is an option and whether it makes sense should be discussed with an experienced doctor.

Further information on this: Shoulder osteoarthritis surgery

Appointment with a shoulder specialist

I would be happy to advise you!

Who am I?
My name is Carmen Heinz. I am a specialist in orthopedics and trauma surgery in the specialist team of .

The shoulder joint is one of the most complicated joints in the human body.

You can find me in:

Lumedis - your orthopedic surgeon
Kaiserstrasse 14
60311 Frankfurt am Main

Pain associated with osteoarthritis of the shoulder

For the pain associated with osteoarthritis of the shoulder, pain medication can be taken simultaneously with the treatment of the inflammation.
So-called NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen or pain relievers such as paracetamol come into question. If these do not provide relief, your doctor may also prescribe opioid analgesics such as tramadol.

It should be noted that drug therapy should not be long-term, as it can lead to many side effects. Cooling the joint during periods of joint inflammation and applying ointments containing painkillers can also reduce shoulder pain.

More on this: Shoulder pain

Will cold or warm help my shoulder?

The application of cold or heat to the shoulder depends on the symptoms. If, for example, there is activated osteoarthritis, which results in inflammation of the joint with redness, swelling, overheating, pain and restricted movement of the shoulder, cold therapy (Cryotherapy) respectively. This can be done with cooling packs or quark wraps.

If the osteoarthritis symptoms are present without inflammatory activity, heat treatments can be carried out. The heat can be applied by means of red light, ointments, fango packs or plasters.

What can you do about the inflammation in the shoulder?

It is important to treat the inflammation in the shoulder as it will further damage the joint and make osteoarthritis in the shoulder worse. In addition, it should be noted that if there is an inflammation in the shoulder, it is a so-called "activated arthrosis" and the shoulder should not be stressed at this stage.
This means that the shoulder should be immobilized during the period of inflammation. The shoulder can be cooled during the inflammatory phase. This will reduce swelling and inflammation.

Anti-inflammatory drugs can also be taken in tablet form. These include, for example, diclofenac or ibuprofen. In addition, ointments that also contain ibuprofen or diclofenac can be applied to the shoulder. The tablets and ointments not only have an anti-inflammatory effect but also have an analgesic effect.
Quark compresses and oils such as caraway seed oil - can be applied to the painful and inflamed shoulder to reduce the inflammation in the joint.

The cortisone injection

If the tablets, ointments or cooling are not effective and the swelling and inflammation of the shoulder persists despite these measures, the doctor can inject a cortisone injection directly into the shoulder joint.
Cortisone has an anti-inflammatory effect and by injecting it can work directly at the site of the inflammation. However, the injection of cortisone should not be done too often, as it can also cause degeneration (destruction) of ligaments and tendons and thus worsen the movement and pain situation of the shoulder.

Read more here:

Effects of cortisone
The cortisone injection - areas of application and side effects

What sport is good for my shoulder?

As a general rule, exercise should not be neglected if you have osteoarthritis of the shoulder, as exercise can improve symptoms such as pain and delay the progression of osteoarthritis.
It is important that the right sport is chosen. The joints should not be loaded with weight. Any sport in the water, such as swimming, aqua aerobics or aqua jogging, is suitable - although you should remember to move your arms so that your shoulders are also active. Gymnastic exercises should also be carried out in which the joints, tendons and muscles are stretched and thus better supplied with blood. In addition, no additional load is exerted on the joints here either.

Find out more about the topic here: Exercise for osteoarthritis

What exercises can help me?

The goal of the exercises should be to strengthen the muscles and ligaments that hold the shoulder joint in place. In addition, the movement should create better blood circulation in the cartilage.

For example, a simple exercise is raising and lowering your shoulders - similar to shrugging your shoulders. This exercise can be done while sitting or standing. The height of the lifting and the speed can be varied. Shoulder circles on both sides or on one side (with arms hanging down) while sitting and changing direction can also improve the symptoms of shoulder arthrosis.
Another exercise is performed lying down: the patient lies flat on his back, then the shoulders are first moved forward and then back.
With the help of an exercise band, the shoulder muscles can be strengthened. To do this, the arms are bent by 90 degrees in the elbow joint, the upper arms lie against the upper body. The palms of the hands grasp the exercise band and point flat towards the ceiling. Now the hands are moved outwards so that the shoulders also rotate outwards.
Another exercise is push-ups on the wall: For this, the patient stands with his face to the wall and performs the push-up movements in this position while standing.

All exercises should be repeated 15-20 times. There are many other exercises that can be done for shoulder osteoarthritis. Which exercise is best can be discussed with a doctor or in physical therapy.

How does diet affect my osteoarthritis of the shoulder?

A healthy lifestyle and thus a healthy diet generally prevents diseases. A healthy diet can therefore also delay the development or progression of joint wear.
Unhealthy foods should be avoided - especially if you already have osteoarthritis of the shoulder - and thus caffeine, alcohol, nicotine and a lot of sugar should be avoided.

In some cases, a vegetarian lifestyle could improve symptoms of osteoarthritis in the shoulder. Whether this helps, however, is very individual and should be tried out. In general, you should pay attention to a balanced diet with sufficient vitamin and mineral intake.

Find out about a suitable one here Diet for osteoarthritis.

Prognosis and prophylaxis

Prophylaxis for the development of osteoarthritis in the shoulder joint is limited to eliminating secondary causes as early as possible, such as the operative fixation of splintered bone parts after a shoulder dislocation.
In the case of known incorrect loads due to weakness in specific muscles, this should be compensated as far as possible.

Osteoarthritis is a progressive incurable disease. By means of the conservative therapeutic measures listed above, an almost symptom-free treatment in low stages of arthritis is possible in many cases.
The mechanical processes and the load-bearing capacity of the shoulder can only be restored to a limited extent. In stages in which endoprosthetic therapy (shoulder prosthesis) is recommended, the chances of success for a satisfactory load-bearing capacity are significantly reduced, especially if the actually stabilizing rotator cuff is damaged.
Should the shoulder joint stiffen, everyday activities such as dressing, daily personal hygiene and housekeeping can often only be carried out with help.

As with all arthritic joints, the prognosis is heavily dependent on the patient, the cause and the individual response to therapy.

What degree of disability is osteoarthritis of the shoulder?

The degree of disability (GdB) describes a functional impairment lasting more than 6 months that is not age-appropriate. The effects of the restriction are rated with points. Effects not only include restricted mobility but also participation in social life.

There is a disability if the GdB is over 20. For example, if a joint replacement has taken place due to osteoarthritis, there is at least a GdB of 20.
If the movement restriction due to osteoarthritis in the shoulder joint has progressed to such an extent that the arm can only be raised by 90 degrees, there is also a GdB of 20. Many other criteria, such as permanent (chronic) pain, are taken into account in the points awarded.

If a degree of disability is determined, a claim can be made for assistance or compensation for disadvantages, such as protection against dismissal, discounts for public transport or use of the driving service.