Osteoarthritis Shoulder (Arthrosis)
Osteoarthritis, also known as “wear and tear” arthritis, is a condition that erodes the smooth lining (articular cartilage) of a joint. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. During movement, the bones of the shoulder joint rub against each other, causing pain.
Osteoarthritis usually affects people over 50 years of age and is common in the glenohumeral (ball and socket) shoulder joint and the acromioclavicular joint (end of collar bone) joint.
There are other forms of arthritis that can affect the shoulder joint. This includes rheumatoid, post-traumatic and rotator cuff tear arthritis.
Rheumatoid arthritis is an inflammatory process that affects the lining of the joint causing swelling and pain. Post-traumatic arthritis can occur after fractures of the upper arm bone or dislocation of the shoulder joint.
Rotator cuff tear arthritis occurs after large, long standing rotator cuff tendon tears. The torn rotator cuff can no longer hold the ball of the joint firm in the socket, causing it to rub up and down. This can damage the surfaces of the joint, causing arthritis in shoulder to develop.
Osteoarthritis Shoulder Symptoms
Your shoulder joint consists of two bones that are covered in cartilage tissue and lubricated and protected by joint fluid. If the cartilage tissue is damaged or worn due to overuse, the two bones in the joint will rub together and the surrounding tissue will become inflamed. This causes pain in the shoulder and restricts mobility. A bit more cartilage and, later, bone tissue is abraded with every movement. The joint becomes more and more deformed.
The most common symptom of arthritis of the shoulder is pain, which is aggravated by activity and progressively worsens.
If the glenohumeral (ball and socket) shoulder joint is affected, the pain can be felt all around the shoulder spreading into the upper arm. The pain is often worse, and the shoulder is stiffer to move first thing in the morning.
The pain of arthritis in the acromioclavicular (AC) joint is focused on the top of the shoulder at the end of the collarbone. This pain can sometimes radiate or travel to the side of the neck.
Someone with rheumatoid arthritis may have pain throughout the shoulder if both the glenohumeral and AC joints are affected.
Limited range of motion is another common symptom. It may become more difficult to lift your arm to comb your hair or reach up to a shelf. You may hear a grinding sound (crepitus) or shoulder clicking as you move your shoulder.
As the disease progresses, any movement of the shoulder causes pain. Shoulder pain at night is common and your sleep may be disturbed.
To be able to start the right treatment for arthrosis in the shoulder, we first perform a comprehensive clinical examination of your shoulder joint. The shoulder joint and its tendons and muscles are examined to identify any major functional deficits or weaknesses.
X-rays are necessary to confirm the diagnosis. The x-ray provides information about the distance between the two joint bones: the more cartilage has already been lost due to friction in the joint, the smaller this spacing is. If there is chronic damage to the rotator cuff, the humeral head under the shoulder socket will be higher on the x-ray. This all confirms the suspicion of arthrosis in the shoulder.
By using ultrasound scans and magnetic resonance imaging (MRI), our specialists can also precisely determine the extent of the defects in the tendon cuff and secondary inflammatory reactions.
To plan a shoulder joint prosthesis, we also perform a computer tomography (CT) if there are larger bone defects and major changes in the original joint. The CT allows our experts, with the help of special computer programmes, to create a 3D simulation of your joint and the surgery to be performed. If necessary, in complex cases, individual, patient-specific implants and devices will be created.
Osteoarthritis Shoulder Treatment
Many people suffer from wear and tear on joints throughout the course of their lives. But shoulder surgery isn’t always necessary. In the early stages of arthrosis, conservative measures can help slow the progress or even prevent it. Here, we combat the pain with physiotherapy, physical applications such as cryotherapy or muscle strengthening.
Conservative treatment methods
In the beginning stages of arthrosis, our specialists initially treat your symptoms conservatively, meaning without shoulder surgery. The combination of pain therapy and physiotherapy can slow the wear on the shoulder and even stop the symptoms.
Pain therapy provides relief
An injection directly into the shoulder joint or upper joint space can provide relief for acute pain in the shoulder. This way, we can reduce the pain and the inflammation in your shoulder joint. Often, this injection treatment is required before further, conservative treatment can begin. Drug-based pain therapy is also often necessary to reduce the pain of active arthrosis. However, pain medications are not a permanent solution.
Improve and maintain mobility with physiotherapy
Once the acute pain has been relieved, we will start targeted exercises that improve mobility in the shoulder joint and release painful tension. Our physiotherapists will help you stretch shortened muscles caused by protective or incorrect posture and strengthen your shoulder muscles. Potentially incorrect posture in the upper sections of the spine can also be corrected in this manner. With improved posture, symptoms can improve.
Shoulder surgery for early-stage arthrosis
If pain persists or conservative treatments fail, shoulder surgery may be helpful. If, in particular, surrounding tissue such as bursa sacs, tendon sheaths or the long bicep tendon are affected, we can improve these problems by means of minor arthroscopic (keyhole) surgeries and significantly reduce the pain caused by arthrosis. Our experts will review, in detail, whether there are options for minimally invasive joint preservation treatment options.
Joint replacement surgery
If arthrosis has progressed to an advanced stage, a joint replacement may be the best solution for you. With this solution, we can reduce your pain long-term and improve the mobility of your shoulder.
Replacement surgery options include conventional total shoulder replacement or reverse total shoulder replacement.
Total shoulder arthroplasty – this requires normal rotator cuff tendons and a good amount of bone remaining in the shoulder. Both the ball and the socket are replaced. A plastic “cup” is fitted into the socket, and a metal “ball” is attached to the top of the arm.
Reverse total shoulder replacement – this is used in patients with torn rotator cuff tendons to allow them to use other muscles to raise their arm and use their shoulder. In this type of replacement, the socket and ball are the opposite way around compared to a conventional total shoulder replacement.
The artificial shoulder joint functions for approximately 10 to 15 years. A number of our patients, however, have used their implants for much longer and enjoy significantly improved pain-free function long term.
As with all surgeries, there are some risks and possible complications. Potential problems could include infection, excessive bleeding, blood clots and damage to blood vessels or nerves. Particular with shoulder replacement surgery, the artificial joint may wear and loosen over time, which may require further shoulder surgery in the future.
All treatment is provided in our state-of-the-art operating theatres with the most up-to-date techniques and implants. The aftercare, however, is just as important, and you will be looked after by the inpatient specialist physiotherapy team and your aftercare with the outpatient physiotherapy teams will be co-ordinated closely to ensure your maximal recovery and return to normal activities as soon as possible.