What are the symptoms and treatment options for Glenohumeral (shoulder) joint arthritis?

Symptoms of Glenohumeral Joint Arthritis

Patients with glenohumeral osteoarthritis typically present with shoulder pain, decreased range of motion, and loss of function, often with a long history of progressive symptoms or acute exacerbations of chronic pain. 1

Primary Clinical Presentation

Pain Characteristics

• Activity-related pain is the hallmark symptom, particularly with overhead activities and throwing motions 2, 3
• Pain may occur at rest in advanced disease, though motion-related pain is more common in earlier stages 3
• Pain is often located in the anterior or anterolateral aspect of the shoulder 2
• Patients may report inability to sleep comfortably on the affected side (only 6% could do so in one study before treatment) 4

Range of Motion Limitations

• Decreased shoulder range of motion is a defining feature, with active ROM averaging only 41% of the unaffected side in severe cases 4
• Specific limitations include:
  • Reduced shoulder elevation 5
  • Decreased internal and external rotation 5
  • Painful limitations with abduction 2
• Capsular stiffness develops, particularly in chronic cases 2

Functional Impairments

• Loss of shoulder function manifests as difficulty with daily activities 1
• Patients report inability to place objects on shelves at shoulder height (only 35% could place 1 lb. on a shelf before treatment) 4
• Decreased velocity and precision in throwing athletes 2
• Progressive disability affecting work and recreational activities 1

Physical Examination Findings

Palpation and Structural Changes

• Tenderness to palpation over affected structures 2
• Shoulder subluxation may be present, particularly in post-stroke patients with associated weakness 2
• Joint stiffness with accessory glide testing 5

Associated Muscle Weakness

• Rotator cuff and scapular musculature weakness associated with pain 5
• Focal weakness with decreased ROM during abduction with external or internal rotation 2
• Abnormal scapular motion develops as adaptation to restricted glenohumeral motion 3

Radiographic Correlation

Imaging Findings

• Joint space narrowing is the primary radiographic feature 6, 7
• Hypertrophic spurring and osteophyte formation in advanced disease 6, 7
• Glenoid erosion and bone loss 7
• Humeral head and glenoid articular surface destruction 1

Disease Progression Patterns

Natural History

• Progressive in nature with irreversible destruction of articular surfaces 1
• Inflammation of surrounding soft tissues contributes to pain 1
• Prevalence increases dramatically with age, affecting 85-94% of individuals over 80 years 8
• More common in women and increases with age 2

Common Clinical Pitfalls

Important Diagnostic Considerations

• Rotator cuff integrity must be assessed, as irreparable tears change surgical management from total shoulder arthroplasty to reverse arthroplasty 6, 7
• Prior shoulder dislocation or stabilization surgery complicates the clinical presentation and increases OA progression risk 5
• Diabetic patients may present with more severe stiffness but respond similarly to treatment 4
• Shoulder pain in post-stroke patients has multifactorial causes including abnormal joint mechanics, tissue injury, and central nociceptive hypersensitivity 2