Shoulder osteoarthritis occurs less frequently than, for example, osteoarthritis of the knee, but it is just as painful, and the suffering of those affected is great. The disease is not curable. But numerous options for alleviating the symptoms can help patients. The last resort for progressive disease may be surgery.
What is shoulder osteoarthritis?
Osteoarthritis of the shoulder refers to a change in the shoulder joint caused by wear and tear. Between the upper arm and the glenoid cavity, which together form the shoulder joint, there is a gap filled with cartilage mass. The purpose of this cartilage is to cushion the pressure that occurs when two bones meet at a joint and to distribute the load evenly. If the cartilage mass becomes less due to wear and tear, both joint parts rub increasingly closer together. This friction causes further wear, inflammation and pain.
Causes
Because the shoulder joint is normally less stressed than, for example, the hip or knee joints, which must constantly bear and move the weight of the entire body, it is less likely to be affected by osteoarthritis than other joints. If the disease nevertheless occurs, it can have various causes. Very often, arthrosis is a phenomenon of advancing age and the associated wear and tear of the joints. But it can also be the result of an accident, such as a poorly healed fracture of the upper arm, or a disease such as rheumatism, a circulatory disorder or a bacterial infection. Family predisposition can also play a role. Regular, one-sided stress, such as during sports or at work, can also lead to shoulder arthrosis after a long period of time. This can affect craftsmen as well as musicians or professional athletes.
Symptoms, complaints and signs
Arthrosis of the shoulder begins insidiously and initially causes little discomfort. The patient may feel pain from time to time, but sees little restriction in his or her actions and movements. If left untreated, the pain worsens and leads to restricted movement. Especially working overhead then often seems impossible. Restrictions of movement occur in all directions. The arm can no longer be spread and reaching upwards will only be possible with pain. Especially those who are active in sports and frequently load the shoulder will feel the pain and will no longer be able to load the shoulder as usual. Especially sports where the shoulder is in focus will then only be possible with pain. These include handball, tennis, shot put or volleyball. The pain is worst when the shoulder is loaded and when the affected person lies on the shoulder. In advanced shoulder osteoarthritis, the joint also hurts at rest. If the patient restricts his movements more and more, shoulder stiffness occurs. In order that the complaints do not increase further and become chronic, timely treatment of shoulder osteoarthritis is advisable.
Diagnosis and progression
Schematic representation of the healthy shoulder under the shoulder osteoarthritis in comparison. Click to enlarge. In osteoarthritis of the shoulder, the humerus and glenoid cavity rub against each other without being adequately protected by the cartilage located in the joint. The result is pain from the mechanical friction, and later inflammation can occur due to the lack of pressure equalization. Initially, the patient experiences the movement of the arm, shoulder or even head as painful. Often a protective posture is then adopted, which leads to poor posture and incorrect loading of other muscles and joints, resulting in further pain. The mobility of the shoulder joint becomes severely limited as the disease progresses, and eventually the affected person feels pain even in a resting posture or during sleep. The joint may lose its mobility completely and stiffen. Daily activities such as getting dressed can thus become enormously difficult. For the diagnosis, a precise description of the symptoms and complaints is useful in an initial discussion. During a physical examination, the mobility of the joint can be checked.An ultrasound examination, an X-ray and a magnetic resonance imaging (MRI) will finally confirm whether shoulder osteoarthritis is actually present and to what extent the wear and tear on bone and cartilage has already progressed. If there is a suspicion that a bacterial or rheumatic disease is the cause, a puncture of the joint is appropriate. In the case of shoulder arthrosis, the affected person must expect complications. These include, first and foremost, joint inflammation. Doctors then speak of activated arthrosis. It appears through increased pain and swelling of the shoulder joint.
Complications
Complications that arise due to osteoarthritis of the shoulder often affect patients’ daily lives. For example, they often suffer from limitations in their range of motion as well as stabbing pain. As a result, the affected person can no longer carry out normal everyday activities without hindrance. If additional stress is placed on the shoulder joint, there is a risk of bone damage in the further course of the disease. For example, there is a risk that the bone will splinter due to the intense friction, resulting in its permanent impairment. How often complications of shoulder osteoarthritis manifest themselves and to what extent they occur varies from person to person. Pain-free periods of several months are just as possible as a rapidly progressing course of the disease. In order to avoid serious sequelae, it makes sense to consult a doctor in order to start treatment at an early stage. Sometimes a surgical intervention may be necessary. A rare consequence of surgery is the formation of an inflammation, which in turn causes an abscess. In this case, pus accumulates in a small cavity. This cavity in turn causes pressure on the adjacent tissue. In some cases, the pus penetrates into the bloodstream, creating the risk of blood poisoning (sepsis).
When should you see a doctor?
In case of shoulder osteoarthritis, the affected person always needs to visit a doctor to avoid further complications and discomfort. Only early diagnosis and treatment of this disease can prevent further discomfort. A doctor should be consulted if the patient suffers from very severe restrictions in movement at the shoulders. Even slight and simple movements of the shoulders cause severe pain, which can have a negative effect on everyday life and also on the quality of life of the person affected. It is not uncommon for the pain to spread to the neighboring regions of the body. If the pain caused by shoulder osteoarthritis is permanent and does not disappear on its own, a doctor must be consulted in any case. Especially after an accident or after a severe injury, a doctor should be consulted. In the case of shoulder osteoarthritis, a general practitioner or an orthopedist can be consulted. In most cases, this results in a positive course of the disease.
Treatment and therapy
Shoulder osteoarthritis is not curable. Acute discomfort can be reduced by injections of painkillers and cortisone, and cold treatments are also found to be soothing. When inflammation in the stressed joint areas has healed with medication and the patient is largely pain-free, physiotherapy is possible. Through targeted exercises, incorrect postures can be corrected and muscles and tendons strengthened in order to relieve the skeleton as best as possible. X-ray stimulation, microwave irradiation and ultrasound can slow the progression of osteoarthritis. In the later stages, arthroscopy can be used to clean out the shoulder joint, and the acromion bursa may be removed during this procedure. If the joint is no longer in a condition worth preserving, the insertion of a prosthesis may be advisable. The physician decides together with the patient in each individual case which type of artificial joint makes the most sense. This largely depends on the degree of damage to the shoulder joint. The operation is usually performed under general anesthesia and requires a rehabilitation phase of several weeks. After about three months, the shoulder can again be used for everyday activities. On average, such a prosthesis lasts about ten years.
Prevention
Shoulder osteoarthritis, like any other form of osteoarthritis, can be well prevented by exercise.Stretching and warm-up exercises are especially important. Sports such as swimming or cycling, which require regular sequences and involve different areas of the musculature, are very suitable. One-sided stress should be avoided. Exercise generally promotes blood flow to the cartilage and thus its longevity. A strong musculature also supports the skeleton and helps to take the strain off the bones. A healthy diet and normal weight are also important for keeping joints healthy.
Aftercare
Because shoulder osteoarthritis cannot be cured, patients will need to take care of their diseased shoulder for the rest of their lives. Even after surgery, which can usually relieve symptoms, there is no guarantee that shoulder osteoarthritis will not reoccur. Therefore, in the aftercare, the recommendations remain the same as those given for self-help and prevention. For example, muscles in the shoulder area should not be tensed on one side. This can be achieved, for example, by setting up the workplace ergonomically and otherwise ensuring sufficient breaks with appropriate relaxation. Age-appropriate sports are indispensable for patients suffering from shoulder arthrosis. The stretching exercises already learned through the physiotherapeutic treatments should continue to be practiced. Stretching classes, yoga or Pilates are also recommended. Anything that strengthens the muscles in the shoulder, neck, back and arm areas is also good. Physiotherapy or even massages are advisable. A healthy diet is also important. After all, the body’s immune system must be able to fight off inflammation and compensate for wear and tear. It can only do this if it is strengthened accordingly. A varied and vitamin-rich diet ensures strong defenses. To avoid destroying this effect, patients should avoid stimulants such as alcohol and nicotine.
What you can do yourself
Shoulder osteoarthritis (omarthrosis) is a disease that can be influenced approximately positively with self-help, but is just as little curable as by classical conventional medical treatment. The reason for this is the joint surfaces, the destruction of which cannot be reversed. Nevertheless, an attempt can be made to stimulate the formation of synovia (synovial fluid) through targeted movement, so that its sliding ability ensures that the joint surfaces do not rub against each other too hard. Movement stimulates the synovia in the joint space. This can bring some relief. However, movement is of central importance in the context of self-help for shoulder osteoarthritis for another reason: namely, if pain causes the patient to rest the joint, it threatens to stiffen and the pain (including immobility) will increase. This vicious circle must be avoided at all costs, and the patient’s cooperation is indispensable in this context. Above all, exercises that train the rotator cuff are important. These and others can be learned from the physiotherapist and performed regularly at home on the patient’s own initiative. There are two other things that patients should pay attention to in the case of shoulder osteoarthritis. One-sided postures and movements should be avoided. It is also important to look at the ergonomics of the workplace. Loosening up during breaks at work is also an important factor here. Furthermore, attention should be paid at night to a comfortable position in bed with a mattress that is suitable for the shoulders.
