Shoulder Pain Management

Glenohumeral Arthritis¹

Presentation and History

Glenohumeral arthritis is not as common as arthritis of the knee or hip, occurring in up to 20% of adults.¹ Osteoarthritis is the most common underlying cause of glenohumeral arthritis.

However, other conditions, including rheumatoid or inflammatory arthritis, osteonecrosis, rotator cuff arthropathy and posttraumatic arthritis can be the root cause. The different causes of glenohumeral arthritis may impact the choice of therapy.

Quick Clinical Points

• Glenohumeral arthritis is less common than arthritis in the knee or hip.
• Pain is the primary complaint at presentation.
• Glenohumeral arthritis is a chronic condition with an insidious onset.
• A thorough patient history may help identify the underlying cause and may suggest an appropriate treatment.

In patients with glenohumeral arthritis, pain is the primary complaint upon presentation. However, shoulder stiffness is a frequent secondary complaint. In some patients, pain and stiffness may be accompanied by a sensation of crepitus during shoulder movement.

The symptoms of shoulder pain are chronic and progressive with an often insidious onset. Activity typically exacerbates pain and stiffness. Patients may suffer sleeplessness from discomfort, especially if the position of sleep involves the affected shoulder.

Symptoms may culminate in obvious functional limitations. Patients may not be able to lift objects or even their arm alone over their head. Reaching behind the back or under the opposite arm may also be limited by shoulder pain and stiffness.

To determine an appropriate treatment course, it is important to document symptom onset as accurately as possible, as well as the duration of symptoms, the degree of disability caused by pain and stiffness, and the activity level of the patient. In addition, all prior treatment attempts should be recorded in the chart, including pain medication, corticosteroid injections, surgical procedures and physical therapy regimens.

A thorough medical history will be useful in determining the severity of arthritis and any factors that predispose the patient to glenohumeral arthritis. Predisposing conditions include corticosteroid use in patients with rheumatoid arthritis and radiation exposure in patients with humeral head osteonecrosis.

Reference