Shoulder cartilage injuries involve damage to the articular cartilage that lines the humeral head and glenoid. Because cartilage has no blood supply and limited ability to repair itself, even localized injuries can progress to chronic pain and early arthritis. Treatment depends on the size, location, and depth of the defect, and on the patient’s age and activity level.
What Are Shoulder Cartilage Injuries?
The articular cartilage of the shoulder is a thin, durable layer covering the ends of the humeral head and the surface of the glenoid. It allows the joint to move almost frictionlessly. When cartilage is damaged, the underlying bone is exposed to higher contact stresses, and without repair the defect can enlarge over time into more significant chondral damage and eventually arthritis.
Shoulder cartilage injuries take several forms:
- Focal chondral defects from acute trauma or impaction
- Partial-thickness lesions from chronic overload or instability
- Full-thickness lesions that expose subchondral bone
- Osteochondritis dissecans, a fragment of cartilage and underlying bone that separates from the joint surface
- Diffuse cartilage wear as part of early glenohumeral arthritis
Location matters clinically. Defects on the humeral head behave differently from defects on the glenoid, and defects in the central contact area of the joint produce more symptoms than peripheral defects.
Causes and Risk Factors
- Acute shoulder dislocation, which can shear cartilage during the event
- Impaction injuries from falls and contact sports
- Osteochondritis dissecans, more common in adolescent throwing athletes
- Chronic instability with repetitive cartilage overload
- Prior rotator cuff disease that alters joint mechanics
- Post-traumatic changes after fractures involving the joint surface
Symptoms
- Deep shoulder pain with activity
- Catching, clicking, or locking in some cases
- Crepitus with joint motion
- Loss of motion, particularly in end-range positions
- Symptoms that do not fit a clear rotator cuff or labral pattern
Diagnosis
Dr. Chudik’s evaluation includes the mechanism (if any) and the pattern of pain. Physical examination assesses motion, crepitus, and rule-out of other shoulder pathology. X-rays evaluate for osteochondritis dissecans, loose bodies, and early arthritic changes. MRI is the imaging study of choice for characterizing cartilage defects, their size, depth, and any associated subchondral bone changes. MRI arthrogram adds sensitivity for subtle lesions. Arthroscopy provides the most definitive assessment and is both diagnostic and therapeutic. The Westmont office has on-site high-field MRI.
Treatment
Non-surgical treatment is appropriate for smaller lesions and early disease. Options include activity modification, anti-inflammatory medication, physical therapy to restore motion and strength, and corticosteroid or hyaluronic acid injections for pain control.
Surgical treatment is considered for symptomatic lesions that do not respond to non-surgical care or for larger defects at risk of progression. Dr. Chudik performs arthroscopic cartilage procedures including:
- Debridement of unstable cartilage flaps
- Microfracture for small full-thickness defects, which stimulates fibrocartilage formation
- Osteochondral autograft transfer for select cases
- Osteochondral allograft transplantation for larger defects
- Removal of loose bodies from osteochondritis dissecans when indicated
The choice of procedure depends on defect size, location, depth, and patient factors.
Recovery and Outcomes
Recovery depends on the procedure. Debridement allows early return to activity within weeks. Microfracture typically requires six to eight weeks of limited loading of the arm followed by progressive motion and strengthening, with return to sport at four to six months. Osteochondral transplantation has a longer recovery, with return to sport typically at six to nine months.
Outcomes for focal cartilage procedures are best when the defect is identified and treated early, before it enlarges or produces secondary damage to the opposing surface.
When to See Dr. Chudik
Schedule an evaluation if shoulder pain does not fit a clear rotator cuff or labral pattern, if you have catching or locking with motion, or if prior imaging has identified a cartilage defect. Call 630-324-0402 or request an appointment online.