Shoulder arthrosis - diagnosis and therapy

If the shoulder is severely painful due to wear and tear, also known as osteoarthritis, and movement is limited, a shoulder prosthesis can help. New developments in recent years have made it possible to replace damaged joint surfaces in a gentle way. In the hands of a specialist, shoulder prosthesis surgery is a routine procedure that can significantly improve quality of life.

How does osteoarthritis of the shoulder joint occur?

Compared to other joints, osteoarthritis of the shoulder joint is relatively rare. In fact, the articular cartilage of the shoulder is subjected to considerably less stress in daily life than, for example, the knee and hip joints. This is because the knee and hip joints must bear the entire body weight with every step. A common cause of wear and tear in the shoulder, also known as omarthrosis, is a previous accident. However, there are also patients who have a predisposition to osteoarthritis, i.e., a certain individual cartilage weakness.

How is osteoarthritis of the shoulder joint diagnosed?

Important indicators of shoulder arthrosis include movement-dependent, stabbing shoulder and upper arm pain, night pain, and usually a significant restriction in arm mobility. Occasionally, an audible movement noise is also present. Advanced shoulder joint wear is clearly visible on X-rays. An ultrasound examination is necessary to determine the usually accompanying damage to the tendons and muscles. If the ultrasound examination cannot definitively clarify the tendon situation, an MRI may also be useful.

How is shoulder arthrosis best treated?

The treatment depends on the extent of wear and tear and the limitations for the patient.

In the early stages of osteoarthritis, conservative, non-surgical treatment is usually sufficient. Anti-inflammatory medications such as antirheumatic drugs (diclofenac, ibuprofen, etc.), ointments, ice applications, and physical therapy are used. These can relieve pain while maintaining mobility. Painful muscle tension can be improved through heat, electrotherapy, and, if necessary, alternative treatments such as acupuncture.

In more advanced stages, additional injections may be necessary. In more severe inflammatory processes, targeted cortisone injections can suppress the inflammation, usually significantly reducing pain. Hyaluronic acid injections improve lubrication of the affected joint. This can improve joint mobility and resilience and also reduce pain and inflammation in a "natural" way.

If conservative measures fail to achieve the desired results, joint debridement can be performed via keyhole surgery (arthroscopy). This "cleaning of the joint" involves removing mechanically disruptive structures and flushing out inflammatory substances from the joint.

However, if the pain persists, the insertion of an artificial shoulder joint must be considered in cases of advanced osteoarthritis.

The artificial shoulder joint

In recent years, enormous progress has been made in the development of new shoulder prostheses. As the number of implanted joints increases, so does the wealth of experience with artificial shoulder joints.

Nevertheless, shoulder replacements should be performed by specialists. While many hospitals already perform large numbers of knee and hip replacements, only a few centers perform a large number of shoulder replacements annually.

Of course, the surgeon’s wealth of experience increases with the number of shoulder joints implanted.

The aftercare

After surgery, the shoulder should be mobilized as quickly as possible. However, to protect the tendons, only certain movements are permitted. The surgeon will decide, depending on the surgical method, what the optimal exercise regimen is for the joint. To achieve optimal results, an 8-10-day hospital stay is usually followed by rehabilitation. This program typically lasts three weeks.

The continuation of physiotherapy treatment should be decided on an individual basis. Patients typically reach a comfortable level of everyday activity after a few weeks. Whether sports can be practiced with an artificial shoulder joint must be discussed with the patient on a case-by-case basis by the treating physician.