Dr. med. Stephanie Adam is a board-certified specialist in orthopedics and trauma surgery with a focus on shoulder and elbow surgery at the Stiftung Marien-Hospital Euskirchen. As a DVSE-certified shoulder and elbow surgeon, she has many years of experience and is considered an expert in treating complex conditions and injuries of these joints. Her medical care is based on state-of-the-art diagnostics, the latest technology, and individualized treatment concepts tailored to the specific needs of her patients.
As head of the Center for Shoulder and Elbow Endoprosthetics, which has been awarded the DVSE Silver Prosthesis Seal, she employs specialized therapeutic procedures for conditions such as omarthrosis (shoulder osteoarthritis) or cuff tear arthropathy. The goal is to restore mobility and relieve pain. To achieve optimal outcomes, she combines modern methods with computer-assisted prosthesis planning and tissue-sparing techniques. Her approach is characterized by thorough diagnostics, transparent counseling, and individualized care. She takes ample time for consultation, explains treatment options clearly, and accompanies her patients from the initial examination through follow-up care.
She is supported by the Marien-Hospital’s modern equipment as well as an interdisciplinary team of nurses, physical therapists, and social services staff. Dr. Stephanie Adam is a respected and highly regarded specialist in shoulder and elbow surgery and is considered a competent point of contact for all questions relating to joint replacement, the treatment of osteoarthritis and injuries, and optimizing mobility after illness. Her many years of experience, professional expertise, and empathetic manner make her a recognized physician in the Euskirchen region and beyond.
In a discussion with Dr. Adam, the editorial team of the Leading Medicine Guide learned more about treating various forms of shoulder osteoarthritis, cuff tear arthropathy, and omarthrosis.
Treatment of cuff tear arthropathy and omarthrosis has made significant progress in recent years. Innovative therapeutic approaches make it possible to restore shoulder mobility and effectively relieve pain. By using modern technologies, tissue-sparing techniques, and individualized treatment concepts, these developments offer new perspectives for patients who previously had to live with considerable limitations. The aim is to significantly improve quality of life and enable sustainable recovery.
Osteoarthritis of the shoulder usually develops gradually due to progressive wear of the joint cartilage. Over time, the cartilage in the joint wears down, causing the bones to rub against each other, which leads to pain, inflammation, and limited range of motion.
“Osteoarthritis, especially what’s known as omarthrosis, is the degeneration of the shoulder joint. We distinguish between primary and secondary omarthrosis. The primary form occurs without external influences and is genetically determined. Some people are simply unfortunate in having an inherited predisposition to osteoarthritis, which is why this wear can develop early. However, secondary omarthrosis is much more common. It’s usually the result of years of heavy strain, as seen in people who perform physically demanding work—whether in construction or other occupations that place significant stress on the shoulder. Over the years, overuse and improper loading take their toll and contribute to the development of osteoarthritis. In addition, there are osteoarthritis cases that arise after injuries. For example, anyone who has had a fracture involving the shoulder joint—especially if it affects the joint surface—has a higher long-term risk of developing post-traumatic osteoarthritis. Any damaged joint carries this risk: once injured, joint cartilage is more prone to osteoarthritis than healthy cartilage. Inflammatory rheumatic causes, such as rheumatoid arthritis, can also lead to osteoarthritis, although thanks to advanced medications such cases have become less frequent in recent years. Other, rarer causes include metabolic disorders like gout. A special form is cuff tear arthropathy, which occurs with a damaged rotator cuff, a group of muscles around the shoulder joint. The supraspinatus muscle, an important part of this cuff, wears out over a lifetime—it ‘degenerates’—so that in many of these patients it is scarcely present. This muscle normally keeps the shoulder centered and stable. If this support is missing, the humeral head gradually migrates upward and loses proper joint guidance, which leads to pain and restricted motion,” explains Dr. Adam, who further details the symptoms:
“Patients with osteoarthritis notice pain that can radiate into the upper arm or the neck-shoulder musculature, as well as restricted movement. These limitations manifest as increasing difficulty abducting the arm to the side, lifting it forward, or rotating it. Some patients can no longer raise the arm to horizontal. Everyday tasks become increasingly difficult: combing hair or getting dressed turn into challenges. Patients often can’t lie on the affected side. Both forms of osteoarthritis share that they are painful and restrict mobility, often accompanied by some loss of strength.”
When the shoulder hurts, even combing hair becomes difficult. (AI-generated)
Diagnosis is usually made through a thorough clinical examination as well as imaging. The physical exam includes assessments of range of motion and pain, during which the physician tests mobility and checks for tender points.
“As soon as a patient presents with the shoulder problems described, the diagnostic process typically begins with a detailed medical history to understand the patient’s background and specific complaints. The next step is imaging, starting with an X-ray in all cases. An X-ray is often very informative, particularly with classic forms of omarthrosis or cuff tear arthropathy. In such cases, typical changes in the shoulder joint can be identified. If the X-ray doesn’t provide enough information, or if the disease is at an early stage, we recommend an additional MRI. MRI offers detailed insights, especially regarding the rotator cuff. This exam can reveal the condition of the muscles—for example, whether the supraspinatus muscle is still intact or whether muscular changes such as fatty degeneration are present. Fatty degeneration indicates a longer-standing injury, for instance because the muscle can’t be used properly due to a damaged tendon. MRI also allows assessment of the cartilage structure, which is important for staging the disease,” explains Dr. Adam.
Before considering surgical treatment for a patient with shoulder osteoarthritis or cuff tear arthropathy, comprehensive conservative therapies are generally used to relieve pain, improve mobility, and preserve shoulder function. These approaches are often successful and can delay—or even avoid—the need for surgery.
Dr. Adam comments: “As with most conditions, conservative treatment precedes any potential surgery for shoulder complaints. In the early stages, typical measures include physical therapy and home exercises to strengthen the musculature and maintain mobility. Many patients also take pain medication, with frequency being highly individual—some only occasionally, others regularly. Anti-inflammatory medications can also be helpful. In addition, physical modalities are often effective: for example, cold therapy can alleviate pain and feel pleasant. Another option is an intra-articular injection aimed at reducing pain and inflammation. Where possible, load reduction for the shoulder is recommended. However, that’s not always feasible for working individuals, as many must continue their jobs,” and adds:
“For most patients with omarthrosis or cuff tear arthropathy, conservative treatment is the first-line approach. Deciding when to intensify treatment or consider surgery depends on treatment success. The diagnosis must be clear. Ultimately, it’s always the patient’s decision based on their level of suffering. In the clinic I always say: there are different options—conservative or surgical—and what matters is how the patient is doing. Some simply want to manage daily life, while others wish to be physically active. The decision is based on individual pain perception. If someone only takes painkillers occasionally and does fine with that, we often wait. But if symptoms are so severe that they massively limit everyday life—for example, pain at rest or at night, making it impossible to lie on the side—then willingness for surgery is much higher. Importantly, the decision to operate always lies with the patient. It’s not made solely on X-rays or MRIs—the patient’s level of suffering is decisive.” 
With the right treatment, shoulder pain relief can be regained. (AI-generated)
Treatment concepts differ between cuff tear arthropathy with tendon damage and omarthrosis, in which cartilage wear is the primary issue, because the underlying causes and clinical pictures are different.
“The surgical workflow for these two osteoarthritis types is similar. If surgery becomes necessary, we begin with precise planning using a computed tomography scan. This imaging captures the exact bony deformities that can occur in both forms of osteoarthritis—on the humeral head and the glenoid. It’s important to consider these deformities individually for each patient, as they can occur on both sides or only one. We use special planning software based on the CT data. With this software, we create a 3D reconstruction of the joint to quantify the extent of the bony changes and select the best implants. The software can also simulate range of motion to determine the optimal solution for each patient. The planning itself is highly individualized and performed by me personally. The CT data are indispensable, and I work directly with the software to plan everything precisely,” says Dr. Adam, continuing:
“As a rule, these osteoarthritis cases always require a total joint replacement. That means both joint partners—the humeral head side and the glenoid—are replaced during surgery. Osteoarthritis affects both sides of the joint, and treating only one side would worsen the situation over time, as the glenoid-side deformity would continue to progress. Osteoarthritis typically advances: it starts with cartilage breakdown. Once the cartilage is completely worn away, bony changes develop, such as osteophytes or deformities. On the glenoid side, wear often progresses posteriorly, which increasingly decentrates the joint and negatively affects muscle and bone alignment. In surgery, depending on severity, a special glenoid reconstruction is required to restore joint centering—especially when deformities and wear are pronounced. The goal is to return the joint to a biomechanically as-normal-as-possible position and preserve mobility.” 
Shoulder joint. (AI-generated)
Tissue-sparing surgery plays a role in treating both cuff tear arthropathy with tendon damage and omarthrosis, as it aims to preserve healthy soft tissue and offers advantages for patients.
“Today, procedures are performed to be as tissue-sparing as possible. However, to access the joint, a small standardized incision is always needed on the front of the shoulder, roughly at the level of the armpit crease. This approach enables instrumentation and the operation itself. In cuff tear arthropathy, the existing defect in the rotator cuff can be used, which simplifies the procedure because no additional muscle needs to be detached. If the rotator cuff is still intact, a muscle must be detached to access the joint and is then reattached at the end of surgery. Overall, the operation lasts about 70–90 minutes, and the patient typically stays in the hospital for 3–4 days. Everything prior to surgery—including planning—takes place on an outpatient basis. Importantly, after surgery we begin early functional treatment, and patients are allowed—and encouraged—to use the arm right away,” emphasizes Dr. Adam.
Individualized treatment for cuff tear arthropathy and omarthrosis is crucial for achieving optimal outcomes and ensuring the best possible quality of life for patients. Because these conditions vary greatly in extent, cause, and patient circumstances, standardized treatment often cannot address all individual needs. Therefore, therapy planning places special emphasis on precise diagnosis, structural damage, age, activity level, comorbidities, and personal expectations. 
After shoulder surgery, rapid and structured follow-up care is crucial to treatment success. To quickly restore mobility and avoid complications, we rely on early mobilization and targeted rehab.
“Immediately after surgery, patients are usually allowed to use the arm without a sling—and should do so. Our specialized team of physical therapists with strong shoulder expertise begins therapy on the first postoperative day. We also use a shoulder motion chair that enables motorized, passive mobilization. The patient sits in a chair with a special support for the arm. With gentle movements—such as abduction or forward elevation—passive mobilization begins, with the device guiding the motion. After the hospital stay, we strongly recommend follow-up rehabilitation, since many patients have had long-standing motion restrictions due to osteoarthritis. Although not mandatory, rehab is highly recommended because it leads to better functional outcomes. Patients can choose between outpatient or inpatient rehab, which we coordinate together with our social services team. Ideally, rehab should begin in the second week after surgery, between day 10 and day 14,” explains Dr. Adam, highlighting the special role of the shoulder motion chair:
“We also provide the shoulder motion chair for home use to support mobilization. The device is delivered on loan, adjusted by an orthotics technician, and briefly demonstrated. It offers passive mobilization with machine assistance. Later, active-assisted movements follow, during which the patient gradually moves the arm more independently, and finally the active phase, where the patient moves the arm unassisted. Consider a fit patient receiving a shoulder prosthesis: it’s quite conceivable they could resume sports such as tennis after about six months. Lighter activities like swimming, gentle cycling, or jogging are often possible after three months.” 
Symbolic image of physical therapy. (AI-generated)
Managing complex shoulder conditions such as cuff tear arthropathy involves several challenges. A central difficulty lies in precisely diagnosing the individual damage to tendons, cartilage, and bone and devising a therapy that is both functionally effective and durable. This is why a high level of medical expertise is required—Dr. med. Stephanie Adam is certified as an expert by the German Association for Shoulder and Elbow Surgery (DVSE).
The DVSE certification held by Dr. med. Stephanie Adam as an expert in shoulder and elbow surgery indicates that she has special expertise and extensive experience in treating conditions in these joint regions. The German Association for Shoulder and Elbow Surgery (DVSE) awards this certificate to physicians who have completed specialized additional training and provided practical evidence of applying complex surgical and conservative procedures in this field. The aim is to ensure high-quality medical care and professional competence in the treatment of shoulder and elbow disorders. 
“As the operating surgeon, I see the greatest challenge in optimally restoring joint alignment when bony deformities are present. Especially on the glenoid side there are often deformities that must be corrected accordingly. Modern implants offer the ability to compensate for various inclination angles, and sometimes bone grafting is required to re-establish a correct joint line. We perform about 40–50 shoulder prosthesis procedures per year, and I’m very satisfied with our technical setup. Today’s implants, planning systems, and navigation aids are highly advanced and already very satisfactory for patients. There are customizable prostheses, stemless designs, short-stem prostheses, and special implants, as well as computer-assisted navigation for particularly difficult cases. The market is well developed, with a large number of providers,” says Dr. Adam, concluding:
“It’s hard to give preventive advice. Load-related damage often depends heavily on one’s occupation; someone who performs physical labor can usually hardly reduce their strain. However, joint-impacting activities should be avoided where possible—especially if there’s a pre-existing condition. Sports that stress the shoulder, such as intense weight training or boxing, should be approached with caution, as they can increase the risk of overuse injuries to the rotator cuff and joint cartilage.” 
A full return to everyday life usually takes about 6 months. (AI-generated)
Thank you very much, Dr. Adam, for this informative conversation!
