Anatomy & Background


Glenohumeral arthritis is the wearing and degeneration of articular cartilage in the glenohumeral joint of the shoulder.

The three most common types of arthritis include osteoarthritis, rheumatoid arthritis and traumatic arthritis, and each can occur in any joint within the body. Glenohumeral arthritis is a common source of shoulder pain in older individuals, but is less common than arthritis in other joints, such as the hip, knee or hands. It is believed to affect as much as 20% of older individuals, and can also affect younger individuals, although the occurrence is less common.

Affected Areas


The glenohumeral joint is one of three joints in the shoulder that allow for mobility of the arm. This shoulder joint is a ball-and-socket joint situated between the head of the humerus (upper arm bone) and the glenoid fossa of the scapula (shoulder blade). The surfaces of the bones that meet in the joint are covered with articular cartilage, a smooth surface that allows the bones to freely slide over one another so the joint moves smoothly. The joint is comprised of a ball (the head of the humerus) that is large and a socket that is small, resulting in a joint that, although mobile, is relatively unstable. It is surrounded by muscles, ligaments, the glenoid labrum and the joint capsule, which all provide stability to the shoulder joint.

Causes


There are a number of different causes of glenohumeral arthritis, and specific causes may depend on the type of arthritis that is experienced in the shoulder. Some common causes of the condition include:

  • Repetitive strain and overuse of the shoulder, whether due to recreational or work-related activities, can accelerate wearing of the joint surfaces and cause damage to joint cartilage, resulting in arthritis.
  • Traumatic injury to the shoulder in the past (including a fall, fracture or dislocation) can later result in the development of arthritis in the glenohumeral joint.
  • Anything that diminishes the stability of the shoulder joint causes increased stress on the areas within the joint, which can lead to arthritis. Ligament damage or damage to the glenoid labrum are examples.
  • Excessive use of steroid medications can cause accelerated degeneration of cartilage in the joint, leading to arthritis.
  • Genetics can make individuals pre-disposed to developing degeneration of cartilage in their joints (arthritis), including glenohumeral arthritis.
  • Diseases that affect the joint, such as rheumatoid arthritis, can result in damage to cartilage in the shoulder.

Signs and Symptoms of Glenohumeral Arthritis


Symptoms of glenohumeral arthritis can vary in severity, but generally include:

  • Pain and swelling around the shoulder joint.
  • Diminished range of motion, mobility and functioning of the shoulder.
  • An aching feeling, or the sensation of “crunching” or “cracking” within the joint.
  • Weakness of the shoulder that can make some movements difficult to perform. This especially affects overhead movements, reaching behind the back, or activities that require lifting.
  • Deformity of the joint can be visible or the joint may appear to be increased in size (due to inflammation and swelling).

Treating Glenohumeral Arthritis


Initial treatment following the onset of symptoms generally relies on the RICE method (rest, ice, compression and elevation). The extent of treatment required for glenohumeral arthritis is dependent on severity of the condition, but the following treatment options may be beneficial:

  • Rest – Limit or avoid activities that cause pain or increase inflammation. Taping, bracing or strapping may immobilize and protect the joint while it heals.
  • Ice – Ice is one of the fastest ways to reduce inflammation and can diminish pain. Ice should not be used for more than 20 minutes at a time and should not be applied directly to the skin.
  • Compression – Apply light compression while icing the area to further reduce swelling.
  • Elevation – Keeping the affected area elevated will help to reduce swelling.
  • Moist heat – If the shoulder joint is stiff, moist heat (like a warm/hot wash cloth) can help to loosen it up. This can be alternated with ice when symptoms flare up and should not be used for more than 20 minutes at a time.
  • Movement – It’s important to avoid activities that exacerbate symptoms, but it is equally important to keep the shoulder joint moving as much as possible. Absence of movement will lead to stiffness, increased pain and diminished function. In the shoulder, it can even lead to adhesive capsulitis (frozen shoulder).
  • Anti-inflammatory and other pain medications – NSAIDs work to reduce inflammation and pain. Additional pain medication may be required while an individual performs therapeutic exercises to stretch and strengthen the joint.
  • Steroid injections – Low doses of steroids may be injected into the shoulder joint to reduce inflammation.
  • Physical therapy – Exercises (therapeutic, stretching and strengthening), neuro-muscular re-education, manual therapy, electrical stimulation, ultrasound and cold laser therapy can diminish pain, reduce inflammation and improve mobility. Initial treatment will focus on reducing inflammation, increasing circulation and protecting the joint. Stretching and strengthening will then be used to improve strength and flexibility in the shoulder in order to reduce stress on the joint.  Individuals will be instructed on ways to stretch, strengthen and protect the joint on their own in order to avoid further flare ups.
  • Surgery – Moderate forms of the condition may require arthroscopic surgery to clean out (debride) the joint surfaces. More severe forms of arthritis may necessitate joint replacement surgery to stop bone-on-bone contact, in order to improve quality of life.

Managing Your Pain


Pain generally accompanies inflammation due to degeneration of the cartilage in the shoulder joint. Pain management techniques may vary by the severity of the condition but generally include:

  • RICE – When symptoms flare up, rest-ice-compression-elevation can initially manage pain and reduce inflammation.
  • Moist heat – If the shoulder joint is stiff, moist heat can help to loosen it up, reducing discomfort.
  • Anti-inflammatory and pain medication – NSAIDs work to reduce inflammation and pain. Additional pain medication may be required while an individual performs therapeutic exercises to stretch and strengthen the joint.
  • Steroid injections – Low doses of steroids may be injected into the shoulder joint to reduce inflammation.
  • Physical therapy – Exercises (therapeutic, stretching and strengthening), neuromuscular reeducation, manual therapy, electrical stimulation, ultrasound and cold laser therapy can diminish pain, reduce inflammation and improve mobility.

Prognosis


Most patients with mild glenohumeral arthritis experience diminished pain and improved functioning within 4 – 6 weeks following conservative treatment, such as rest, NSAIDs and therapeutic exercises.

Moderate forms of the condition, in which patients experience more extensive pain, weakness and loss of mobility or function, may require more aggressive treatment, including possible arthroscopic surgery to debride the joint surfaces, followed by physical therapy. If this occurs, recovery can expect to take 6 – 12 weeks following surgery before stability, strength and functioning is restored.

Severe glenohumeral arthritis may necessitate joint replacement surgery due to significant pain, stiffness and loss of functionality brought on by bone-on-bone contact. If this occurs, recovery can require 3 – 6 months of intensive physical therapy following surgery, although additional functional gains can continue for up to a year. Quality of life is typically significantly improved following joint replacement surgery, although there will still be some limitations to mobility and function.