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WILDERMAN MEDICAL CLINIC
Anatomy of the Glenohumeral Joint
The glenohumeral joint, or GH joint, connects the bone of the upper arm, the humerus, with the torso.
The ball-shaped end of the humerus called the humeral head fits into a concave socket at the tip of the scapula, or shoulder blade, called the glenoid fossa, hence the name, the glenohumeral joint.
This ball-and-socket joint allows for movement in a wide range of directions. A group of muscles referred to as the rotator cuff stabilizes and generates movement in this joint; these muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis.
How does osteoarthritis develop in the glenohumeral joint?
The shoulder is a complex structure that allows for a wide range of motion.
Because of the heavy and repetitive use that the shoulder typically experiences, injuries and degenerative conditions like osteoarthritis are common.
Osteoarthritis begins with damage to the cartilage inside the GH joint; the job of this cartilage is to protect the joint and allow for smooth, gliding movements. When the cartilage is damaged, movements in the GH joint cause friction, which results in inflammation in the joint.
Friction and ongoing inflammation can result in damage to the bones in the joint, causing bony overgrowth, called bone spurs. These spurs cause pain, reduced range of motion, and further inflammation and degenerative changes.
What are the symptoms?
Symptoms of glenohumeral joint osteoarthritis typically include:
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Pain and tenderness in the GH joint
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Stiffness
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Reduced range of motion in the shoulder
How common is osteoarthritis of the glenohumeral joint?
Due to the complex structure of the shoulder joint, as well as the heavy and repetitive demands often placed on it, shoulder injuries are common. A journal article published in 2016, titled “Glenohumeral osteoarthritis”, noted that “[GH joint osteoarthritis] causes significant pain, functional limitation, and disability with an estimated prevalence of between 4% and 26%.”
The authors of the article further noted that “shoulder problems account for 2.4% of all general practitioner consultations in the UK and 4.5 million visits to physicians annually in the USA.” The authors also report that 32% of patients over the age of 60 have shoulder arthritis. (Thomas et al. 2016)
What are the risk factors associated with osteoarthritis of the glenohumeral joint?
Some factors that contribute to the degeneration of the GH joint cartilage include:
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Mechanical injury to the shoulder joint, such as a fracture or dislocation
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Other inflammation-related medical conditions, like rheumatoid arthritis
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Obesity
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Age
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Family history
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Overuse or repetitive use of the shoulder joint, common in professions such as construction or sports like tennis
How is the condition diagnosed?
For glenohumeral joint osteoarthritis to be diagnosed, you will require a doctor’s appointment. Your appointment will consist of the following:
A complete medical history
Your doctor will extensively discuss your medical history with you, gathering general information such as what medications you are taking and what other medical conditions you have as well as asking questions relating to your shoulder pain specifically.
These questions will include pertinent information such as what type of signs and symptoms you are experiencing when those symptoms first began, what movements and positions aggravate your pain, and what types of treatments or tests you have had so far relating to your shoulder pain.
A physical examination
A physical exam will test for tenderness in the GH joint or pain that is triggered by certain movements or positions.
This will help to pinpoint the source of your pain, allowing the physician to distinguish between several issues, including shoulder instability (such as a dislocation injury), acromioclavicular joint diseases, rotator cuff injury, or GH joint pathology.
Making a correct diagnosis is crucial to managing and treating the issue correctly.
Diagnostic imaging
Your physician may send you for diagnostic imaging, such as an X-ray, to determine degenerative changes like narrowing of the joint or bone spurs formation in the GH joint. Using radiographic imaging, GH joint osteoarthritis is classified using the Samilsonn-Prieto classification system, which has four grades, ranging from 0, which is normal, to 3, which is severe.
How is the condition treated?
After a diagnosis of glenohumeral joint osteoarthritis, the approach that is best for you will depend on several factors, including how old you are, the severity of your pain and your resulting limitations, and your overall health.
While arthritic changes are not reversible, there are numerous options available to manage pain and slow or even prevent the progression of degenerative changes.
Some of these treatment options include:
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Acetaminophen to reduce pain
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NSAIDs (non-steroidal anti-inflammatory drugs) to reduce pain and inflammation
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Other oral medications specific to treating arthritis and inflammation
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Topical creams, such as Lidocaine, Menthol, Traumeel, and Tiger Balm
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Physiotherapy
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Aquatics or pool therapy program
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Hot/cold therapy, using heat and ice to reduce pain and swelling
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Acupuncture and Acupressure
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Massage therapy
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Occupational therapy (including improving the ergonomics of your workstation, if applicable)
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Exercise to reduce weight and improve body mechanics or exercise modification if your workout routine is a source of aggravation to the GH joint
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Dietary changes to reduce weight and inflammation
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Smoking cessation
What do we do at WMC?
At the Wilderman Medical Clinic, we offer a variety of interventional and non-interventional treatment options aimed at reducing pain and increasing function.
These options include:
Interventional pain management for osteoarthritis of the GH joint:
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Cortisone point injections
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PRP (plasma-rich protein) injections for GH joint osteoarthritis
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nStride injections for GH joint osteoarthritis
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Dextrose (prolotherapy) injections for GH joint osteoarthritis
Non-interventional pain management for osteoarthritis of the GH joint:
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Psychotherapy
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Kinesiology education sessions
When is surgery required?
When all conventional options have been exhausted, patients with moderate to severe glenohumeral joint osteoarthritis may be advised to consider surgical options.
Some of these options include:
- Osteotomy, which involves the removal of bone spurs from the GH joint to reduce friction, thereby reducing pain and increasing the range of motion.
- Debridement of the shoulder joint involves the removal of loose cartilage fragments, smoothing out the remaining cartilage to reduce friction.
- A shoulder replacement is the last option available to treat GH joint osteoarthritis, and involves removing the damaged joint and replacing it with an artificial one; this option requires a long recovery process and extensive physical therapy.
Works Cited
Thomas M, Bidwai A, Rangan A, Rees JL, Brownson P, Tennent D, Connor C, Kulkarni R. Glenohumeral osteoarthritis. Shoulder Elbow. 2016 Jul;8(3):203-14. doi: 10.1177/1758573216644183. Epub 2016 Apr 25. PMID: 27583021; PMCID: PMC4950285.
