The shoulder joint is the most mobile joint in the human body, but it is also prone to wear and tear. When the cartilage between the head of the humerus and the glenoid cavity wears away, doctors refer to this as shoulder osteoarthritis or omarthrosis. This degenerative shoulder condition often leads gradually to limited range of motion and shoulder pain, which occurs particularly at night or during physical activity. Whether conservative treatment with physical therapy and injections is sufficient or whether a specialist recommends surgical treatment depends on the stage of the osteoarthritis. The goal of any treatment for shoulder osteoarthritis is to reduce inflammation, relieve pain, and preserve mobility for as long as possible before a joint replacement becomes necessary.
What is shoulder osteoarthritis?
The term osteoarthritis refers to wear and tear of the cartilage and bones in various joints. Shoulder osteoarthritis, also known as omarthrosis, occurs when one or both shoulders are affected.
Symptoms of shoulder osteoarthritis
In every joint, the bones are protected by cartilage. The cartilage also ensures that the joint is “lubricated,” allowing movement to be—in the truest sense of the word—smooth. When the cartilage layer wears down excessively, it can no longer perform its important functions: the bones rub against each other. This is painful and causes inflammation in the joint.
Typical symptoms of shoulder osteoarthritis include:
- Shoulder pain
- Limited range of motion in the arms
- a crunching sound and sensation in the shoulder joint
- possible swelling of the joint
At first, the pain occurs mainly after exertion or when lying on the shoulder. As the condition progresses, however, the shoulder may also ache constantly even at rest.
Shoulder osteoarthritis begins slowly and progresses steadily over time. This can lead to distinct flare-ups: The shoulder may cause no problems for quite some time, but after overexertion—or even without any apparent cause—pain and restricted movement suddenly increase.
Causes of shoulder osteoarthritis
Osteoarthritis is usually preceded by minor damage to the cartilage or tendons. This damage can result from an injury, but also from excessive strain or poor posture. Circulatory problems or inflammation in the shoulder area can also contribute to the development of osteoarthritis. In rare cases, shoulder osteoarthritis develops without any apparent cause.
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Diagnosis of shoulder osteoarthritis
If you experience shoulder pain and suspect osteoarthritis, the first step is to consult a doctor. The doctor will ask about your medical history, any past injuries, and whether there is a family history of similar conditions. Information about your lifestyle can also provide important clues. During a physical examination, the doctor will also assess the shoulder’s range of motion and palpate the joint.
If the suspicion is confirmed, an X-ray will provide a more detailed view of the joint. AnMRI scan is often useful as a supplementary test. During this examination, images of individual layers of the joint are captured inside a “tube.” Sometimes the doctor will also perform an ultrasound examination or test the blood for signs of bacterial inflammation. All of these tests provide an accurate picture of the condition of the shoulder joint and the surrounding tissue. Arthroscopy is a minimally invasive procedure used for both accurate diagnosis and simultaneous surgical treatment; the video shows the procedure:
Conservative Treatment Options for Shoulder Osteoarthritis
As with many diseases, the same principle applies to shoulder osteoarthritis: the earlier it is treated, the better the potential treatment outcomes. If the wear and tear is not yet too advanced, it can be treated conservatively—that is, without surgery.
Various methods are available for this:
- Medications to relieve pain and reduce inflammation in the joint help alleviate acute symptoms and prevent further tissue damage.
- Physical therapy exercises strengthen the shoulder and correct poor posture. They also help prevent the muscles and tendons from stiffening.
- Lifestyle changes in daily life help ensure that the shoulder is not subjected to continued improper strain.
- Physical therapy uses heat, cold, or electrical stimulation to relieve pain and promote healing.
- Sometimes, injection treatments with cortisone, hyaluronic acid, or the patient’s own plasma (PRP) can provide long-term relief from symptoms.
Possible Surgical Options for Shoulder Osteoarthritis
If joint wear in the shoulder can no longer be adequately treated with conservative methods, various surgical options may be considered as part of shoulder surgery. During the procedure, the doctor removes areas of inflammation in the shoulder or repairs any injuries.
If even these methods are no longer sufficient, a shoulder prosthesis—that is, an artificial shoulder joint—may be implanted.
Prognosis for shoulder osteoarthritis
Cartilage wear in joints cannot be completely cured. However, various treatment methods can slow its progression and relieve pain. Conservative or surgical treatment significantly improves patients’ quality of life; pain is reduced or disappears entirely, and mobility can be improved or fully restored.
How good the prognosis is depends heavily on the individual case. As a general rule, the earlier treatment begins, the better the results. So don’t wait too long—if you’re experiencing symptoms, see a specialist as soon as possible!
FAQ: The 8 Most Important Questions About Shoulder Osteoarthritis (Omarthrosis)
What are the typical symptoms of shoulder osteoarthritis?
Shoulder osteoarthritis develops gradually. The main symptom is deep-seated shoulder pain that often radiates down the arm. Initially, these symptoms occur only during physical activity; later, patients also experience pain at rest, even at night, making it impossible to lie on the affected shoulder. As the cartilage in the shoulder joint wears down, mobility decreases, leading to noticeable limitations in shoulder movement. Patients often notice a crunching sound when the bones rub against each other.
What does conservative treatment for shoulder osteoarthritis involve?
Conservative therapy is the first step in treating shoulder osteoarthritis. It aims to reduce inflammation and relieve pain. This includes pain-relieving medications (analgesics) and anti-inflammatory ointments. Physical therapy is an essential component for strengthening the muscles and maintaining shoulder mobility. Physical therapies such as heat or cold can also help. During acute flare-ups, an injection of cortisone or hyaluronic acid directly into the joint space can provide relief.
When is surgery necessary for omarthrosis?
Surgery is usually considered when conservative treatment fails to bring about improvement over an extended period and cartilage degeneration in the shoulder joint is well advanced. When pain and limited mobility significantly impair quality of life, surgery is often unavoidable. Depending on the condition of the rotator cuff and the bone, an anatomical or reverse shoulder prosthesis may be implanted to replace the shoulder joint.
What factors contribute to shoulder osteoarthritis?
In addition to age-related wear and tear (primary osteoarthritis), there are many factors that contribute to shoulder osteoarthritis. These include previous injuries such as fractures of the humeral head or dislocations (secondary osteoarthritis). A common cause is what is known as defect arthropathy, in which a chronic tear in the rotator cuff causes the humeral head to rub against the acromion and the scapula, destroying the cartilage. Inflammatory conditions such as rheumatism also attack the articular cartilage.
How is shoulder osteoarthritis diagnosed?
To diagnose shoulder osteoarthritis, the orthopedic surgeon first performs a physical examination to assess range of motion and identify tender points. Imaging studies are necessary to accurately assess the extent of cartilage wear. An X-ray shows the narrowed joint space and bony spurs (osteophytes). An MRI or CT scan provides information about the condition of the tendons and muscles, which is important for planning surgical treatment.
What can you do on your own to relieve the symptoms?
To slow the progression of the condition, overhead activities and heavy lifting should be avoided. Regular, gentle shoulder movement (e.g., pendulum exercises) helps prevent stiffness. A balanced diet and weight management relieve strain on the body in general, even though the shoulder is not a weight-bearing joint. For acute shoulder pain, cooling often helps, while for chronic symptoms, heat is more effective for relaxing the muscles.
What role does physical therapy play?
Physical therapy is essential for shoulder function. Targeted exercises strengthen the muscles around the shoulder blade and the head of the humerus. This stabilizes the joint and relieves pressure on the damaged joint surfaces. An experienced physical therapist will demonstrate exercises that promote mobility without aggravating the inflammation.
Are there specialists for shoulder osteoarthritis?
Yes, the treatment of shoulder osteoarthritis should be handled by a specialist in orthopedics and trauma surgery. A shoulder surgery specialist can assess the type of shoulder osteoarthritis present and determine whether joint-preserving therapy or the use of a shoulder prosthesis is the best option. Information about shoulder osteoarthritis and second opinions should always be sought before undergoing major surgery.
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