{"id":14453,"date":"2023-03-13T15:31:48","date_gmt":"2023-03-13T15:31:48","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=14453"},"modified":"2026-07-16T11:05:16","modified_gmt":"2026-07-16T10:05:16","slug":"glenohumeral-osteoarthritis","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/musculoskeletalphysiotherapy\/shoulderelbow\/glenohumeral-osteoarthritis\/","title":{"rendered":"Glenohumeral joint osteoarthritis"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>Patient resources<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/services.nhslothian.scot\/musculoskeletal\/self-help-information\/\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian MSK Self Help Resources Webpage<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.shoulderdoc.co.uk\/section\/24\" target=\"_blank\" rel=\"noreferrer noopener\">Shoulder Doc: Shoulder Arthritis<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/versusarthritis.org\/about-arthritis\/conditions\/osteoarthritis-oa-of-the-elbow-and-shoulder\/\" target=\"_blank\" rel=\"noreferrer noopener\">Versus arthritis: Osteoarthritis (OA) of the elbow and shoulder<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Definition<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Shoulder&nbsp;(glenohumeral joint) osteoarthritis (OA) is characterized by age related changes of articular cartilage and subchondral bone with narrowing of the glenohumeral joint.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Typical signs and symptoms<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pain, stiffness and loss of function.<\/li>\n\n\n\n<li>Global restriction of active and passive movement in a capsular pattern.<\/li>\n\n\n\n<li>Reduced passive external rotation is key sign.<\/li>\n\n\n\n<li>May have crepitus on movement.<\/li>\n\n\n\n<li>Catching or locking may represent presence of loose fragments.<\/li>\n\n\n\n<li>Symptoms may fluctuate with acute-on-chronic flares.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">A diagnosis of OA should be suspected if a person is 45 years or over with:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Activity related joint pain.<\/li>\n\n\n\n<li>No morning joint-related stiffness, or morning stiffness lasting no longer than 30 minutes.<\/li>\n\n\n\n<li>Possible functional limitation.<\/li>\n\n\n\n<li>Examination findings may include: restricted and painful range of joint movement, bony swelling, joint deformity, mild synovitis or joint effusion, crepitus, and joint instability.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Prevalence and risk factors<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">5%-17% of patients with shoulder complaints.&nbsp;The prevalence of OA varies depending on the joint(s) affected, the person\u2019s age, sex, socio-economic group, and comorbidities.&nbsp;&nbsp;Primary OA is rare, secondary OA accounts for the majority of cases such as following trauma, surgery, osteochondritis dissecans and synovial chondromatosis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Risk factors: advancing age, female &gt; 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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Prognosis\/ risks factors for poor outcome<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>OA is not always a progressive condition.<\/li>\n\n\n\n<li>Symptoms may fluctuate with intermittent acute-on-chronic flares.<\/li>\n\n\n\n<li>Prognosis will depend on contributing factors &#8211; 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.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Other considerations<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>OA is largely a clinical diagnosis and doesn\u2019t always require an x-ray.<\/li>\n\n\n\n<li>Arrange an x-ray if there is diagnostic uncertainty, atypical features, or sudden worsening symptoms.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Differential diagnoses<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Important to note that restricted passive external rotation can be seen in other disorders such as frozen shoulder, avascular necrosis and dislocation.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Relevant standards and guidelines<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/cks.nice.org.uk\/topics\/shoulder-pain\/management\/glenohumeral-joint-osteoarthritis\/\" target=\"_blank\" rel=\"noreferrer noopener\">NICE Clinical Knowledge Summaries: Glenohumeral joint osteoarthritis<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/cks.nice.org.uk\/topics\/osteoarthritis\/\" target=\"_blank\" rel=\"noreferrer noopener\">NICE Clinical Knowledge Summaries: Osteoarthritis<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/bess.ac.uk\/wp-content\/uploads\/2020\/06\/Glenohumeral-osteoarthritis.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">BESS: Patient Care Pathway: Glenohumeral Osteoarthritis<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>P.A &amp; M.A \u2013 16-7-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who can refer: <\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>All primary care clinicians with relevant appropriate scope of practice i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners <\/li>\n\n\n\n<li>Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP <a href=\"https:\/\/services.nhslothian.scot\/musculoskeletal\/where-to-find-us\/\" target=\"_blank\" rel=\"noreferrer noopener\">Where To Find Us \u2013 Musculoskeletal Physiotherapy<\/a>)<\/li>\n\n\n\n<li>Secondary care consultants and associated teams<\/li>\n\n\n\n<li>MSK physiotherapists who identify patients with suspected serious conditions of the shoulder or elbow shoulder follow agreed pathways and processes <a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian Integrated Shoulder &amp; Elbow Service<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who and How to refer:<\/h4>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table><thead><tr><th>Condition<\/th><th>Referral Type<\/th><th>Referral destination and process<\/th><\/tr><\/thead><tbody><tr><td><strong>Suspected septic arthritis\/ septic bursitis<\/strong><\/td><td>Same day<\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected facture or dislocation<\/strong><\/td><td>Same day<\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected acute distal biceps rupture<\/strong><\/td><td>Same day<\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected acute traumatic rotator cuff tear in the younger patient<\/strong><\/td><td>Urgent<\/td><td><strong>Orthopaedics<\/strong> via SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics- Elbow &amp; Shoulder<\/td><\/tr><tr><td><strong>Suspected malignancy\/ tumour specific to shoulder*<\/strong><\/td><td>Urgent<\/td><td><strong>Orthopaedics<\/strong> via SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics- Elbow &amp; Shoulder<\/td><\/tr><tr><td><strong>Suspected inflammatory condition<\/strong><\/td><td>&nbsp;<\/td><td>Consider referral to <strong>Rheumatology<\/strong> \u2013 see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Rheumatology.<\/a><\/td><\/tr><tr><td><strong>Suspected neurological condition<\/strong><\/td><td>&nbsp;<\/td><td>Consider referral to <strong>Neurology<\/strong> \u2013 see&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Neurology.<\/a><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">* <em>Please also see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/sarcoma\/\" target=\"_blank\" rel=\"noreferrer noopener\">Sarcoma \u2013 RefHelp<\/a>. 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&nbsp;detailed on <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatric-radiology\/gpaccesstoctforsuspectedcancernoclinicallyobviousprimary\/\" target=\"_blank\" rel=\"noreferrer noopener\">GP Access to CT for Suspected Cancer (No Clinically Obvious Primary) \u2013 RefHelp<\/a><\/em><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients who have the presence of significant red flags\/ suspicion of serious shoulder and elbow conditions or have suspected inflammatory condition &#8211; see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/serious-shoulder-and-elbow-conditions-red-flags\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/serious-shoulder-and-elbow-conditions-red-flags\/\" target=\"_blank\" rel=\"noreferrer noopener\">serious shoulder &amp; elbow conditions<\/a><\/li>\n\n\n\n<li>Age &lt;16<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">For further information see associated sections<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li>Link to NHS Lothian patient internet site including patient information resources \u2013&nbsp;<a href=\"https:\/\/services.nhslothian.scot\/ises\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/ISES\/Pages\/default.aspx<\/a><\/li>\n\n\n\n<li>Link to NHS Inform page shoulder &nbsp;problems&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/shoulder-problems\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/shoulder-problems<\/a><\/li>\n\n\n\n<li>Link to NHS Inform shoulder problems- Patient self help guide&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/self-help-guides\/self-help-guide-shoulder-pain\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/self-help-guides\/self-help-guide-shoulder-pain<\/a><\/li>\n\n\n\n<li>Link to NHS Inform page elbow problems&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/elbow-problems\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/elbow-problems<\/a><\/li>\n\n\n\n<li>Link to intranet site NHS Lothian Integrated Shoulder and Elbow Service&nbsp;<a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Patient resources NHS Lothian MSK Self Help Resources Webpage Shoulder Doc: Shoulder Arthritis Versus arthritis: Osteoarthritis (OA) of the elbow and shoulder Definition Shoulder&nbsp;(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 A diagnosis of OA should be<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4425,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[904,1414],"class_list":["post-14453","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-glenohumeral-osteoarthritis","category-https-apps-nhslothian-scot-refhelp-shoulder-conditions"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/shoulder-elbow\/https-apps-nhslothian-scot-refhelp-shoulder-conditions\/https-apps-nhslothian-scot-refhelp-glenohumeral-osteoarthritis\/\" rel=\"tag\">Glenohumeral osteoarthritis<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/shoulder-elbow\/https-apps-nhslothian-scot-refhelp-shoulder-conditions\/\" rel=\"tag\">Shoulder conditions<\/a>","rttpg_excerpt":"Patient resources NHS Lothian MSK Self Help Resources Webpage Shoulder Doc: Shoulder Arthritis Versus arthritis: Osteoarthritis (OA) of the elbow and shoulder Definition Shoulder&nbsp;(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 A diagnosis of OA should be","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14453","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=14453"}],"version-history":[{"count":8,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14453\/revisions"}],"predecessor-version":[{"id":28988,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14453\/revisions\/28988"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4425"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=14453"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=14453"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}