Glenohumeral joint osteoarthritis

Patient resources

Definition

Shoulder (glenohumeral joint) osteoarthritis (OA) is characterized by age related changes of articular cartilage and subchondral bone with narrowing of the glenohumeral joint.

Typical signs and symptoms

Pain, stiffness and loss of function.
Global restriction of active and passive movement in a capsular pattern.
Reduced passive external rotation is key sign.
May have crepitus on movement.
Catching or locking may represent presence of loose fragments.
Symptoms may fluctuate with acute-on-chronic flares.

A diagnosis of OA should be suspected if a person is 45 years or over with:

Activity related joint pain.
No morning joint-related stiffness, or morning stiffness lasting no longer than 30 minutes.
Possible functional limitation.
Examination findings may include: restricted and painful range of joint movement, bony swelling, joint deformity, mild synovitis or joint effusion, crepitus, and joint instability.

Prevalence and risk factors

5%-17% of patients with shoulder complaints. The prevalence of OA varies depending on the joint(s) affected, the person’s age, sex, socio-economic group, and comorbidities. Primary OA is rare, secondary OA accounts for the majority of cases such as following trauma, surgery, osteochondritis dissecans and synovial chondromatosis.

Risk factors: advancing age, female > male, history of joint trauma/ fractures, obesity, lifestyle, occupational stresses, genetics, certain metabolic diseases e.g. diabetes, haemochromatosis, inflammatory arthritis; traumatic or degenerative rotator cuff tears.

Prognosis/ risks factors for poor outcome

OA is not always a progressive condition.
Symptoms may fluctuate with intermittent acute-on-chronic flares.
Prognosis will depend on contributing factors – OA is a complex multi-factorial condition involving genetic, biological (age, obesity, metabolic health, genetics), lifestyle (physical activity, smoking, alcohol) and biomechanical (joint injury and structural changes) components.

Other considerations

OA is largely a clinical diagnosis and doesn’t always require an x-ray.
Arrange an x-ray if there is diagnostic uncertainty, atypical features, or sudden worsening symptoms.

Differential diagnoses

Important to note that restricted passive external rotation can be seen in other disorders such as frozen shoulder, avascular necrosis and dislocation.

Relevant standards and guidelines

NICE Clinical Knowledge Summaries: Glenohumeral joint osteoarthritis

NICE Clinical Knowledge Summaries: Osteoarthritis

BESS: Patient Care Pathway: Glenohumeral Osteoarthritis

P.A & M.A – 16-7-26

Who can refer:

All primary care clinicians with relevant appropriate scope of practice i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners
Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP Where To Find Us – Musculoskeletal Physiotherapy)
Secondary care consultants and associated teams
MSK physiotherapists who identify patients with suspected serious conditions of the shoulder or elbow shoulder follow agreed pathways and processes NHS Lothian Integrated Shoulder & Elbow Service

Who and How to refer:

Condition	Referral Type	Referral destination and process
Suspected septic arthritis/ septic bursitis	Same day	Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000
Suspected facture or dislocation	Same day	Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000
Suspected acute distal biceps rupture	Same day	Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000
Suspected acute traumatic rotator cuff tear in the younger patient	Urgent	Orthopaedics via SCI gateway > Lauriston Buildings > Orthopaedics- Elbow & Shoulder
Suspected malignancy/ tumour specific to shoulder*	Urgent	Orthopaedics via SCI gateway > Lauriston Buildings > Orthopaedics- Elbow & Shoulder
Suspected inflammatory condition		Consider referral to Rheumatology – see RefHelp Rheumatology.
Suspected neurological condition		Consider referral to Neurology – see RefHelp Neurology.

* Please also see Sarcoma – RefHelp. If clinical assessment leads to a very strong suspicion of suspected underlying malignancy, with no specific localising signs or symptoms to suggest a specific underlying primary, consider recommendations and referral options detailed on GP Access to CT for Suspected Cancer (No Clinically Obvious Primary) – RefHelp

Who not to refer:

Patients who have the presence of significant red flags/ suspicion of serious shoulder and elbow conditions or have suspected inflammatory condition – see serious shoulder & elbow conditions
Age <16

For further information see associated sections