Shoulder osteoarthritis (arthrosis)

An individualised treatment plan to relieve your shoulder pain

Even the simplest of tasks like putting on a jacket, washing your hair, or reaching up to a high shelf can cause pain for some people. When every arm movement causes a flash of pain through your body, your quality of life deteriorates. If this is the case, wear and tear in your shoulder (arthrosis) could be cause.

There are a number of ways to effectively treat arthrosis in your shoulder, resolving the issue, reducing your symptoms and allowing you to return to a normal function again. Our arthrosis specialists at Schoen Clinic have several years of experience and highly customised treatment concepts, tailored to each individual case for maximum effect. We will get your pain under control with the help of medication, conservative measures, or if necessary, by means of surgery.

Arthrosis or Arthritis? Understanding the difference

While the two may sound similar, it is important to note that arthrosis and arthritis are not the same thing. Arthritis is the ‘umbrella’ term which covers all types of arthritis, from rheumatoid or psoriatic, to osteoarthritis or gout. Arthrosis is the type of arthritis more commonly known as osteoarthritis. It is the medical term for chronic and slowly progressing wear and tear of a joint, the condition occurs when the cartilage that lies in the joint space between your bones begins to deteriorate.

Shoulder arthrosis: What is damaged?
Your shoulder consists of three bones that are covered in cartilage tissue, lubricated and protected by joint fluid. The two main bones which make up the shoulder joint are the scapula (shoulder blade) and the humerus (upper arm bone). 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. As more of the cartilage is worn away over time, the bone is abraded with every movement and the associated pain can increase as the condition progresses.

Symptoms indicating osteoarthritis of the shoulder

Shoulder pain is the most common symptom of arthritis of the shoulder, which is aggravated by activity and increasingly worsens over time. As there are several possible types of arthritis that can affect the shoulder, there is a range of symptoms to be wary of.

Limited range of motion
Grinding or clicking sounds with movement
Shoulder pain at night
Pain around the shoulder spreading into the upper arm
Pain and stiffness are often worse first thing in the morning, or after long periods of rest
Pain on top of the shoulder or end of the collarbone
Pain can sometimes be felt in the side of the neck

Causes: How does shoulder arthrosis occur?

Osteoarthritis 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. Though osteoarthritis is one of the most common, there are other types of arthritis that can affect the shoulder joint. These include 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 the shoulder to develop.

Attaining an accurate diagnosis

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. Special imaging will be required to confirm the condition of your bones and joint space.

Diagnostic imaging

X-rays are necessary to confirm the diagnosis. The X-ray provides information about the distance between the two joint bones: the more cartilage already lost due to friction in the joint, the smaller this spacing becomes. If there is chronic damage to the rotator cuff, the humeral head under the shoulder socket will be higher on the X-ray. This confirms the 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 may 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.

Finding the right treatment

Many people suffer from wear and tear on joints throughout the course of their lives. But shoulder surgery is not always necessary to relieve the symptoms. In the early stages of arthrosis, conservative measures can help slow the progress or even prevent it. Initially, our specialists combat the pain with physiotherapy, physical applications such as cryotherapy or muscle strengthening. The combination of pain therapy and physiotherapy can slow the wear on the shoulder and even stop the symptoms enough to avoid the need for shoulder surgery.

Conservative treatment methods

Pain therapy provides relief
Improve and maintain mobility with physiotherapy

Surgical treatment methods

Shoulder surgery for early-stage arthrosis
Joint replacement surgery

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. Particularly in surrounding tissue such as bursa sacs, or when the long bicep tendon or tendon sheaths are affected, we can improve these problems by means of minimally invasive arthroscopic (keyhole) surgeries, and significantly reduce the pain caused by arthrosis. Our experts will review in detail, whether there are viable options for minimally invasive joint preservation treatment.

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 replacement/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 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. Particularly, with shoulder replacement surgery, the artificial joint may wear and loosen over time, which may require further shoulder surgery in the future.

Shoulder surgery rehab is key

All treatment is provided in our state-of-the-art operating theatres with the most up-to-date techniques and implants. The aftercare is just as important though, and you will be looked after by the inpatient specialist physiotherapy team. 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.

Osteoarthritis of the shoulder: Our specialists

Schoen Clinic London is home to some of the most highly experienced leaders in the field of shoulder conditions. A multidisciplinary team combines expertise from a number of specialities to ensure you receive an accurate diagnosis, appropriate treatment and expert aftercare.