Glenohumeral Osteoarthritis

Glenohumeral osteoarthritis is a primary disease process affecting the lining of the shoulder called the articular cartilage.  Why some individuals become susceptible to osteoarthritis and not others is not entirely understood but there are risk factors for the development of shoulder arthritis, including high occupational demands, frequent use of the arm for high loads as with weightlifting, and genetic predisposition.  Glenohumeral osteoarthritis most commonly affects older individuals but is increasingly recognized as a cause of pain and loss of function in younger and middle aged adults.

When the articular cartilage, or the smooth lining of the joint, wears out, the other issues including the labrum (the spongy “bumper” that increases the concavity of the socket) and the bones can become eroded and painful.  The motion in the shoulder becomes only possible with the glenoid bone rubbing on the humerus bone and the result is inflammation, pain, stiffness, loss of motion, and limitation of function.

Patients with glenohumeral osteoarthritis typically have gradual pain development, often times over months or years, of deep and radiating shoulder pain, morning and inactivity stiffness, and loss of motion.  Sometimes function can be impaired and loss of enjoyment of activities like golf, tennis, or swimming become pronounced.  Night pain and discomfort, particularly with laying on the affected side, can occur but frequently it is activity-related pain with use of the arm during the day that becomes a more concerning feature of pain presentation.  Sometimes the pain can radiate into the trapezial or neck area and frequently to the upper arm and sometimes to the forearm.

The diagnosis of glenohumeral osteoarthritis is made with radiographs of the shoulder which are performed by shoulder surgeon Dr. Obermeyer in the office setting.  The classic features of shoulder arthritis including loss of joint space, spurs (also known as osteophytes), cysts, and hardening of the inflamed bone known as sclerosis, are observed.  Physical examination is performed to exclude associated conditions affecting the soft tissues, including the rotator cuff, although this is sometimes supplemented with MRI.  Dr. Obermeyer will discuss advanced imaging with you if necessary, particularly if you are considered a candidate for surgery.

The treatment of glenohumeral osteoarthritis is initially directed at preserving function, which sometimes includes simple stretches and light strengthening exercises.  Depending on the extent of arthritis affecting your shoulder, formal physical therapy is sometimes not very helpful, as therapy often will stress the shoulder in different positions which can worsen pain symptoms and potentiate the inflammatory process.  Oral anti-inflammatories can help arthritis pain as with other joints.  Injection treatments such as corticosteroids can be helpful to temporarily improve symptoms.  Depending on the specific patient circumstances and extent of the arthritis, some patients may be candidates for injection of a “gel” material called hyaluronic acid, which is a naturally occurring substance ordinarily found in our joints but purified for injection into the shoulder.  These injections are not always helpful and Dr. Obermeyer will discuss with you whether this is an option in your specific case.

In some select cases, arthroscopic debridement for glenohumeral osteoarthritis can be helpful, particularly for younger active patients with milder forms of osteoarthritis and with preserved motion.  This procedure involves treating some of the pain generators around the shoulder, including debriding (cleaning up) the cartilage and labrum, removing spurs and loose bodies, decompressing the tendon of the rotator cuff, and treating the biceps tendon which is often also involved in the pain and inflammatory process(1).  Sometimes this is used as a temporizing procedure prior to anticipated requirement for shoulder replacement, but not always, and Dr. Obermeyer will discuss with you whether this will be helpful in your case.

For most patients with glenohumeral osteoarthritis, total shoulder replacement is considered the gold standard and most durable treatment.  Total shoulder replacement achieves excellent pain relief, recovery of function, with predictable return to activities.  Total shoulder replacement involves resurfacing the glenohumeral joint with a metal and plastic prosthesis, as well as rebalancing and releasing the soft tissues to completely restore function in the shoulder.  Most patients having total shoulder replacement are highly satisfied with the results of the procedure.

Dr. Obermeyer will discuss the option of shoulder replacement in detail with you.  Dr. Obermeyer performs shoulder replacement with novel, state of the art implants, that preserve bone, and allow for optimized revision options should you require surgery for some reason in the future.  Dr. Obermeyer performs more shoulder replacement than any surgeon in the area and is well versed in the design, manufacture, and optimization of achieving optimal patient satisfaction for patients electing to undergo this operation.