What are the findings of shoulder Osteoarthritis (OA)?

From the Guidelines

Examination findings of shoulder osteoarthritis (OA) typically include pain with movement, decreased range of motion, and crepitus, and the most recent and highest quality study suggests that a comprehensive assessment should include evaluation of pain, function, physical activity, BMI, and ability to perform daily tasks and work 1. When examining a patient with suspected shoulder OA, it is essential to assess for tenderness over the glenohumeral joint, which is often most pronounced anteriorly.

• Range of motion testing will frequently reveal limitations, particularly with external rotation and abduction.
• Crepitus—a grating sensation felt during joint movement—is a hallmark finding.
• Muscle strength testing may show weakness due to pain inhibition rather than true muscle weakness. Advanced cases often present with joint deformity and muscle atrophy around the shoulder girdle. Pain is typically worse with activity and improves with rest. Provocative tests like the painful arc test may be positive, though these are not specific to OA. Radiographic correlation is essential, as physical exam findings alone cannot definitively diagnose shoulder OA. X-rays typically show joint space narrowing, subchondral sclerosis, osteophyte formation, and possibly subchondral cysts. These physical examination findings help distinguish shoulder OA from other conditions like rotator cuff pathology or adhesive capsulitis, though overlap can occur, especially in older patients where multiple shoulder pathologies may coexist, and according to the standards of care for people with osteoarthritis, patients should receive a treatment plan with a shared treatment target set between them and a health professional 1. The development of patient-centred standards of care for osteoarthritis in Europe suggests that people with OA should have access to a health professional competent in making a (differential) diagnosis, and should receive information tailored to their needs within 3 months of diagnosis by health professionals about their disease and all aspects of living with and managing their OA 1. In terms of treatment, the American Academy of Orthopaedic Surgeons has developed evidence-based clinical practice guidelines for the treatment of glenohumeral osteoarthritis, which include recommendations for nonsurgical and surgical treatment options 1. However, the most recent and highest quality study suggests that people with OA should achieve optimal pain control using pharmacological and non-pharmacological means, and should achieve optimal function using pharmacological and non-pharmacological means 1. Overall, the examination findings and treatment of shoulder OA should be guided by the most recent and highest quality evidence, with a focus on improving patient outcomes and quality of life.

From the Research

Shoulder OA Findings

• Glenohumeral osteoarthritis (OA) is one of the most common causes of shoulder pain, with patients presenting shoulder pain and decreased shoulder range of motion (ROM) 2.
• Abnormal scapular motion is also seen in patients as adaptation to the restricted glenohumeral motion 2.
• Conservative treatment options for shoulder OA include physical therapy, pharmacological therapy, and biological therapy 2.

Treatment Options

• Physical therapy is performed to decrease pain, increase shoulder ROM, and protect the glenohumeral joint 2.
• Administration of pharmacological agents is the major part next to physical therapy in the conservative treatment, with non-steroidal anti-inflammatory drugs recommended as first-line therapy 2.
• Biologics such as platelet-rich plasma, bone marrow aspirate concentrate, and mesenchymal stem cells have gathered increased attention, but further evidence is needed to determine their effectiveness 2.
• A combined approach of activity modification and physical therapy can be effective in athletes, while oral medications can provide patients with transient pain relief 2.

Multimodal Treatment Approach

• A multimodal treatment approach, including soft tissue therapy, phonophoresis, diversified spinal and peripheral joint manipulation, and rotator cuff and shoulder girdle muscle exercises, has been shown to be effective in resolving symptoms associated with shoulder impingement syndrome 3.
• A multimodal/multicomponent approach, based on different combinations of non-pharmacological and pharmacological interventions, may be an appropriate solution for the management of patients affected by knee OA, and potentially shoulder OA 4.
• Combining nonpharmacologic and pharmacologic treatments is common, but higher pain ratings are associated with multiple failed prescription treatments 5.

Intra-Articular Non-Steroidal Anti-Inflammatory Drug Injections

• Intra-articular non-steroidal anti-inflammatory drug injections may be an alternative therapy for the treatment of osteoarthritis, possibly minimizing systemic side effects while maintaining efficacy 6.
• Single doses of IA NSAIDs appear safe and efficacious across animals and humans, but the optimal use of IA NSAIDs is still to be determined and further research is needed 6.