Shoulder / Arm

Osteoarthritis of the Shoulder

Definition

Osteoarthritis of the glenohumeral joint is an osseous degenerative abnormality of this joint.

Aetiology

The cause of osteoarthritis of the glenohumeral joint can be traumatic in origin (sport injuries), or related to systemic diseases such as rheumatoid arthritis, infections of the joint, and hemiplegic conditions.

Segmental dysfunction of the cervical spine and cervicothoracic junction can play a role in the clinical picture. Therefore, in addition to the evaluation of shoulder function, it is very important to examine the cervical spine as well.

Signs and symptoms

The complaint pattern is characterised by shoulder pain that increases after each time it takes a load. Nocturnal pain and the inability to sleep on the affected shoulder point in the direction of an inflammation.

The location and radiation pattern of the pain can provide information on whether it is caused by a primary pathology of the shoulder, or that it is located outside the shoulder.

In particular, in non-traumatic shoulder pain with an abnormal natural course, other serious diseases, such as generalised joint pain, fever, malaise, weight loss, dyspnoea and angina pectoris, should be explored. Most importantly, a pancoast tumour must be excluded.

Diagnostics

Physical Examination

Examination of the shoulder in osteoarthritis of the glenohumeral joint:

Three groups of shoulder tests are important in examination of the shoulder: 1. active and passive shoulder abduction; 2. active and passive shoulder external rotation; and 3. active and passive horizontal shoulder adduction. Serious shoulder pathology, presenting as brachialgia, can be diagnosed by means of these tests.

In addition, it is important to perform passive shoulder abduction in external rotation. Passive abduction should be performed as often as possible in the frontal plane.

The most characteristic motion restriction in osteoarthritis of the glenohumeral joint is serious or absent active and passive external rotation.

DISORDER

Passive External Rotation restriction

Active Abduction restriction

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Neutral Rotation Position Arm

Passive Abduction restriction

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External Rotation Position Arm

Passive Horizontal Abduction restriction

Osteoarthritis Glenohumeral Joint

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Capsulitis Glenohumeral Joint

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Additional Somatic Diagnostics

  • In the initial phase of uncomplicated shoulder complaints, no imaging techniques and laboratory examinations are indicated.
  • If systemic diseases or other serious conditions are suspected in shoulder pain, blood tests are indicated (CRP, Hb, BSE, rheumatoid factors).
  • When shoulder pain persists, X-ray, ultrasound and MRI scan are indicated.
  • A bone scan is indicated when metastases or primary tumours are suspected.

Somatic Treatment

Pharmacological treatment

Other Treatments

Interventional Pain Treatment