What is degenerative joint disease of the shoulder?

What is Degenerative Joint Disease of the Shoulder?

Degenerative joint disease of the shoulder, also called glenohumeral osteoarthritis, is a progressive wearing away of the smooth cartilage that cushions your shoulder joint, leading to bone-on-bone contact, pain, stiffness, and loss of motion. 1, 2

How Your Shoulder Joint Breaks Down

Your shoulder is a ball-and-socket joint where the round top of your arm bone (humeral head) fits into a shallow socket (glenoid). Normally, smooth cartilage covers both surfaces, allowing pain-free movement. 2

In osteoarthritis, this protective cartilage gradually wears away through a process involving:

• Chronic inflammation inside the joint that releases damaging chemicals and enzymes that break down cartilage 3
• Loss of the smooth, spherical joint surfaces as the underlying bone begins to remodel abnormally 2
• Thickening and tightening of the joint capsule (the tissue surrounding your joint), which further restricts your ability to rotate your shoulder 2
• Progressive destruction of both the humeral head and glenoid surfaces that is irreversible 4

What Causes It

Primary osteoarthritis develops mainly from aging and natural wear-and-tear over time. 5

Secondary osteoarthritis results from specific causes including:

• Previous shoulder injuries or surgeries 3
• Chronic overuse from repetitive overhead activities 3
• Shoulder instability (a loose joint that has dislocated or subluxed repeatedly) 3
• Old fractures involving the shoulder joint 4

Who Gets It

• More common in women than men 1
• Increases with age, affecting up to one-third of people over 60 years old 4
• Third most common joint requiring replacement surgery after the knee and hip 1

What You'll Experience

Pain is typically:

• Worse with weight-bearing activities and movement 5
• Present during overhead activities 2
• May occur at rest in advanced cases 4

Stiffness manifests as:

• Difficulty after periods of inactivity 5
• Progressive loss of shoulder rotation 2
• Reduced ability to reach overhead or behind your back 4

Loss of function includes:

• Limitations in daily activities like dressing, grooming, or reaching 4
• Long-standing history of gradually worsening symptoms 4
• Possible acute flare-ups of chronic pain 4

Associated problems may involve:

• Cognitive and psychosocial difficulties from chronic pain 3
• Inflammation of surrounding soft tissues 4

How It's Diagnosed

Your doctor will identify shoulder arthritis through:

• Medical history focusing on previous injuries, surgeries, pattern of pain, and functional limitations 2, 4
• Physical examination checking range of motion, strength, pain with specific movements, and joint stability 2
• X-rays showing cartilage loss, bone spurs, and joint space narrowing 2, 5
• CT scan if surgery is being considered, to evaluate bone quality and shape of the socket 3
• Blood tests only if needed to rule out other types of arthritis causing secondary osteoarthritis 5
• Joint fluid analysis (arthrocentesis) in select cases to exclude other conditions 5

Treatment Options Available

The American Academy of Orthopaedic Surgeons provides guidance on managing shoulder osteoarthritis, though they acknowledge that evidence for many treatments remains limited. 1

For mild disease:

• Over-the-counter pain medications like acetaminophen or NSAIDs (ibuprofen, naproxen) 2
• Physical therapy to maintain motion and strengthen surrounding muscles 1, 2

For moderate disease:

• Corticosteroid injections into the joint (though evidence is inconclusive) 1
• Hyaluronic acid injections, which may provide longer-lasting relief than corticosteroids 3

For severe disease refractory to conservative treatment:

• Total shoulder arthroplasty (replacing both the ball and socket) is moderately recommended over hemiarthroplasty (replacing only the ball) 1
• Arthroscopic debridement or capsular release for select cases 1, 2
• Surgery should be performed by experienced surgeons (those doing at least 2 shoulder replacements per year have better outcomes) 1

Important Considerations

Surgery is NOT recommended if:

• You have an irreparable rotator cuff tear, as this significantly affects outcomes 1

The disease is progressive:

• Once cartilage is destroyed, it cannot regenerate 4
• Treatment focuses on symptom management and maintaining function 5
• Surgical intervention becomes necessary when conservative measures fail to control pain or restore acceptable function 4