Shoulder arthrosis (Omarthrosis)

The articular surfaces of each joint are covered with cartilage, which enables the two joint partners to move smoothly in relation to each other. In the shoulder joint, however, cartilage degradation can occur with age, due to overloading of the shoulder (e.g. through excessive power sports or excessive physical stress at work) or as a result of accidents. The resulting incongruence of the joint and cartilage softening of the surrounding articular cartilage, leads to an acidic joint milieu, which in the further course is responsible for an increasing destruction of the joint, the inflammation of the joint mucosa and the capsule, and not least for muscle function restrictions. As a result, the joint surfaces can no longer interact optimally with each other during movements and sometimes severe pain and movement restrictions can occur in the affected joint.

This disease is called osteoarthritis and can affect any joint in the human body. The problem is that the cartilage is practically unable to recover from this process due to its lack of blood supply. Compared to the kneeand hip joint, the shoulder joint is far less frequently affected by arthrosis.

Signs of shoulder osteoarthritis may include:

• Start-up pain, B. in the morning after getting up
• Stress pain
• Later rest and night pain
• Limited mobility of the shoulder, especially overhead movements

The typical complaints of shoulder arthrosis include pain in the affected joint. However, this pain is not necessarily caused by the arthrosis alone, but mostly by an accompanying inflammation of the joint (arthritis).

Shoulder arthrosis can become noticeable in the early stages through so-called start-up pain. This refers to pain that occurs at the start of an activity, e.g. in the morning after getting up. Thereafter, the pain initially improves somewhat with increasing movement and then recurs after prolongedexertion (exertion pain). If the disease continues to progress, the symptoms can intensify to such an extent that severe joint pain also occurs at rest and at night. If necessary, the pain radiates into the arm or neck.

In addition, there is an increasing restriction of movement of the affected shoulder. This is particularly noticeable when moving the arm above the horizontal (e.g. when washing hair, throwing) and when moving the arm behind the back (e.g. when tying an apron). This can lead to severe impairment of everyday life for those affected.

Causes of shoulder osteoarthritis are:

• Primary: unknown cause
• Secondary: as a result of other diseases or injuries

Shoulder osteoarthritis can be divided into primary and secondary forms.

Primary shoulder osteoarthritis is the more common form of shoulder osteoarthritis. In this form, no triggering event is known and the cause can therefore not be determined. Risk factors include, for example, advanced age, obesity or the anatomical malposition of the shoulder joint.

Secondary shoulder osteoarthritis is caused by a disease or an injury to the shoulder joint that has led to cartilage degeneration. For example, a fracture of the humeral head, a shoulder dislocation or a rotator cuff lesion can be considered. Inflammatory processes, such as rheumatic diseases, can also lead to secondary joint destruction.

Our shoulder specialists will ask you about your complaints in a detailed interview (anamnesis). This will be followed by a functional examination to check the mobility and strength of your shoulder.

To confirm the diagnosis, an X-ray of your shoulder is taken. Typical signs of arthrosis are a narrowing of the joint space, which is caused by cartilage wear, and bone attachments (osteophytes). It is important to know here that the severity of the arthrosis, which is determined in the X-ray image, often does not correlate with the symptoms. This means that a pronounced arthrosis can be visible in the X-ray image, which, however, causes only relatively minor complaints in everyday life.

To rule out other clinical pictures of the shoulder that need to be differentiated, a magnetic resonance imaging (MRI) or computed tomography (CT) scan is helpful.

If osteoarthritis is diagnosed at an early stage, an improvement in mobility and pain can usually be achieved by means of conservative therapy measures. In the late stages of arthrosis, a minimally invasive surgical intervention up to and including joint replacement (endoprosthesis) is often necessary. However, this decision must be made individually and depends, for example, on the age of the person affected and his or her activity in everyday life. Our shoulder specialists at Orthozentrum Freiburg will be happy to advise you further in this regard.

Conservative therapy:

The following conservative therapies are available:

• Medicinal therapy: analgesics
• Cortisone injections into the shoulder joint
• Physical therapy: cold for acute inflammation, otherwise heat
• Physiotherapy

To reduce the pain and inhibit the inflammation in the joint, painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs) can be used. If this is still not sufficient to significantly improve the pain situation or to contain the inflammatory reaction, an additional cortisone injection can be given into the shoulder joint. However, this is at best a temporary, symptomatic treatment and is not a long-term solution. In the case of mild to moderate arthrosis, the injection of hyaluronic acid into the joint, among other things, has also proven effective.

For acute inflammation of the shoulder joint, cold in the form of cooling pads can bring pain relief. It is important that the cooling pad is not placed directly on the skin, but wrapped with a kitchen towel. Acute inflammation can be recognized by typical signs of inflammation: The shoulder is reddened and swollen, the skin over the joint feels warm, and the pain in the shoulder joint is significantly stronger than usual.

If the joint is not acutely inflamed, a heat application can be helpful to relax tense, aching muscles in the shoulder and neck area (hot roll, cherry stone bag).

In addition, physiotherapeutic treatment should be started to mobilize the affected shoulder joint and strengthen the surrounding muscles (rotator cuff). If the shoulder is not moved sufficiently due to severe pain and the joint capsule is not kept elastic in the process, joint stiffness can result.

Operation:

If the conservative options do not lead to the desired success, the only remaining option is surgical therapy, depending on the patient's level of suffering. In the early phase of osteoarthritis or in cases of minor cartilage damage, arthroscopic procedures still have their place. By eliminating the inflammation and/or smoothing the cartilage, the pain can sometimes be significantly alleviated. Frequently, cutting the long biceps tendon can also help relieve pain. In the case of localized cartilage damage, cartilage regenerative procedures offer the possibility of improving the situation in the joint.

In extreme cases, the shoulder joint must be replaced by an artificial joint(endoprosthesis). There are various options and different types of prosthesis. The choice of implant depends on various factors. The extent of the joint wear and the bone quality (previous fracture of the humeral head, existing osteoporosis) play a decisive role. Possible anatomical changes of the shoulder joint and the functional capacity of the shoulder stabilizing muscles (rotator cuff) are also taken into account.

If the rotator cuff is still intact, so-called anatomical prostheses are used. Either only the humeral head (shoulder cap prosthesis) is replaced or a pedicle anchorage (cementless/cemented) is also performed. In addition, in most cases the glenoid cavity (total shoulder endoprosthesis) is also replaced.

If the rotator cuff is no longer intact and there is advanced arthrosis, the head of the humerus is replaced with a so-called inverse total shoulder arthroplasty (inverse shoulder TEP). This involves reversing the anatomical shape of the two joint partners and shifting the center of rotation of the joint toward the center of the body and downward. This choice of prosthesis gives the deltoid muscle more preload and partially takes over functions that were sometimes performed by the rotator cuff.

Total shoulder arthroplasty surgery at a glance:

• Operation time: 90-120 min
• Anesthesia: General anesthesia
• Clinic stay: inpatient
• Fit for work: after 6-8 weeks
• Return to sports (RTS): after 6 months (depending on the sport)

After a total shoulder arthroplasty, the arm of the affected shoulder is either positioned in a so-called abduction cushion or immobilized in a sling bandage. This means that the arm does not lie directly against the side of the body, but rests on the cushion. This depends on the preservation or function of the rotator cuff.

Further aftercare depends on the surgical method and the inserted prosthesis. Physiotherapeutic, passive movement exercises of the arm should ideally be started on the first day after surgery. Rehab is not infrequently recommended.