How is shoulder arthrosis treated?
As is often the case, the therapy of shoulder arthrosis is divided into the conservative and the operative part. In principle, conservative measures are preferable to surgery. Shoulder arthrosis cannot be cured by conservative (non-operative) measures.
All relevant treatment measures are aimed at: a. The aim is to preserve the function of the shoulder and minimize the progression of shoulder arthrosis. The treatment options include
- A pain relief
- Maintenance and improvement of joint mobility and
- Muscle Strengthening
- Painkillers (analgesics)
- Non-steroidal anti-rheumatic drugs (NSAIDs) – for pain therapy, especially in the inflammatory phase of the disease (e.g. Diclofenac, Ibuprofen, Arcoxia)
- Cortisone – injected into the joint (intra-articular) or under the acromion (subacromial) for strong anti-inflammatory effects
- Hyaluronic acid – Hyaluronic acids belong to the group of so-called chondroprotectives.
- Hyaluronic acid is a natural building block of cartilage that is lost in osteoarthritis.
If hyaluronic acid is injected directly into a joint damaged by arthrosis, the quality of the remaining cartilage improves, which has a positive effect on pain and mobility.
- Physiotherapy – to maintain joint mobility and muscle strengthening (active and passive movement exercises, stretching, manual therapy, isometric muscle building and much more)
- Physical therapies – cooling, pain-relieving current applications, iontophoresis
- X-ray stimulation
Painkillers can be the main treatment for shoulder arthrosis. It is very important to slowly increase the dosage of the medication and start with lighter pain medication. In this way, if the pain increases, you retain the option of increasing the dosage and not exhausting the maximum dosage right at the start of the therapy.
In addition, a permanent pain therapy should be avoided due to the strong side effects. In the case of acute complaints, medication such as paracetamol, ibuprofen or diclofenac should be started. The advantage of the latter two is that they have an anti-inflammatory effect in addition to relieving the pain, thus preventing inflammation of the diseased joint.
Diclofenac can also be applied directly to the affected area in the form of a cream known as Voltaren®. It is absorbed in the corresponding area and is especially effective there. In this way side effects in other parts of the body can be reduced.
If these drugs are no longer sufficient, stronger painkillers such as tramadol, which belongs to the opiate group, are also used. Shoulder joint cleaning (debridement) as part of a shoulder joint endoscopy (arthroscopy) and possibly the simultaneous removal of the bursa of the acromion can only provide some temporary relief. The gold standard (recommended therapy) in the surgical treatment of severe shoulder arthrosis is endoprosthetic joint replacement (shoulder prosthesis).
In this procedure, the worn parts of the humeral head and the shoulder span (glenoid) are replaced with artificial materials. In the last 20-30 years there has been great progress in the development of shoulder prostheses. Modern shoulder prostheses can reproduce the complicated, interindividually varying anatomy (structure) of the shoulder, leaving the surgeon with almost all options for selecting the optimal prosthesis for the patient. Permanent stiffening of the shoulder joint (arthrodesis) and removal of the shoulder joint without replacement (resection arthroplasty) are reserved for particularly complicated cases, for example after failed joint replacement or bacterial infection (both very rare).
