Glenohumeral arthritis is the progressive loss of the cartilage surfaces that line the ball and socket of the shoulder joint. As the cartilage fails, the joint narrows, bone grinds on bone, and shoulder motion becomes painful and restricted. Glenohumeral arthritis is less common than knee or hip arthritis but produces comparable functional loss when it occurs, because the shoulder is the joint most people rely on for overhead and reaching work.
What Is Glenohumeral Arthritis?
The glenohumeral joint is the articulation between the humeral head (the ball) and the glenoid (the socket). The joint surfaces are covered with a thin layer of articular cartilage that allows the bones to glide against each other almost frictionlessly. Cartilage has no blood supply and relies on joint fluid for nutrition, which limits its ability to repair itself.
In glenohumeral arthritis, the cartilage gradually thins and fails. Bone ends become exposed and begin to grind directly against each other. The joint develops bone spurs around its edges, the capsule stiffens, and the rotator cuff is often secondarily affected as the shoulder mechanics deteriorate.
Glenohumeral arthritis takes several forms:
- Primary osteoarthritis: age-related wear, typically in patients over 60
- Post-traumatic arthritis: after a prior fracture, dislocation, or surgery
- Rotator cuff arthropathy: arthritis that develops after a massive, untreated rotator cuff tear, with the humeral head riding high against the acromion
- Inflammatory arthritis: from rheumatoid arthritis or related conditions
- Avascular necrosis: loss of blood supply to the humeral head, leading to collapse and secondary arthritis
Causes and Risk Factors
- Age, with increasing prevalence through the sixth and seventh decades
- Prior shoulder trauma, including fractures of the humeral head or glenoid, and prior dislocations
- Prior shoulder surgery, particularly instability procedures
- Massive chronic rotator cuff tears
- Rheumatoid arthritis or other inflammatory conditions
- Chronic corticosteroid use, heavy alcohol use, or sickle cell disease (risk factors for avascular necrosis)
- Heavy manual labor involving repetitive overhead loading
Symptoms
- Deep shoulder pain, often in the back of the shoulder, worse with use
- Pain at night that disrupts sleep
- Progressive loss of motion, particularly external rotation and overhead reach
- Grinding, crepitus, or catching during arm motion
- Weakness and difficulty with daily tasks such as dressing, reaching into cupboards, and lifting
Diagnosis
Dr. Chudik’s evaluation includes the pain pattern, functional limitations, and prior shoulder history. Physical examination documents range of motion, crepitus, and strength, with attention to rotator cuff integrity. X-rays are the primary imaging study and show joint space narrowing, bone spurs, and changes in humeral head position. CT is added when the glenoid bone stock needs detailed assessment for surgical planning. MRI evaluates the rotator cuff, which is frequently involved and changes the surgical plan significantly. The Westmont office has on-site high-field MRI and X-ray.
Treatment
Non-surgical treatment is appropriate for early arthritis and for patients who are not yet candidates for replacement. Options include:
- Activity modification to reduce provocative loading
- Anti-inflammatory medication
- Physical therapy focused on preserving motion and strengthening the periscapular and rotator cuff muscles
- Corticosteroid injection for flare control
- Hyaluronic acid injection in selected cases
When symptoms progress and non-surgical treatment no longer controls pain or function, surgical options include:
- Total shoulder arthroplasty for patients with preserved rotator cuff function and adequate glenoid bone stock
- Reverse total shoulder arthroplasty for patients with rotator cuff arthropathy or significant rotator cuff deficiency
- Arthroscopic debridement for younger patients not yet ready for replacement
- Arthroscopic Biologic Total Shoulder Resurfacing, a technique Dr. Chudik developed as an arthroscopic alternative to traditional replacement that preserves bone stock and the rotator cuff
Recovery and Outcomes
Recovery after total or reverse total shoulder arthroplasty typically includes four to six weeks of sling protection, progressive range of motion over two to three months, and strengthening over three to four months. Return to most daily activities occurs by three to four months. Pain relief is generally reliable across arthroplasty types. Motion recovery depends on the pre-operative stiffness, the integrity of the rotator cuff, and rehabilitation adherence.
When to See Dr. Chudik
Schedule an evaluation if shoulder pain and stiffness are interfering with sleep, work, or daily activity, or if prior treatment no longer controls symptoms. Call 630-324-0402 or request an appointment online.