Clinical Presentation of Shoulder OA

• Shoulder OA:

  • Onset: can be insidious or posttraumatic
• Shoulder OA:

  • History:
  • progressive, activity related pain thats deep in the joint and often localised posteriorly
  • night pain becomes more common as the disease progresses
  • more common in the older population, pts older than 60 years old
  • previous trauma, dislocation, or previous surgery for shoulder instability are factors associated with the development of osteoarthritis in younger pts
• Shoulder OA:

  • Subjective:
  • pain is present at rest and interferes with sleep
  • pain may not be present with activities
  • stiffness, especially after periods of inactivity
  • decreased function and range of motion
• Shoulder OA:

  • Objective:
  • crepitus on range of motion
  • joint effusion
  • decreased range of motion specifically in abduction and external rotation
  • may have atrophy and decreased muscle strength, following disuse - can cause cycle of muscle inhibition and decrease strength
• Shoulder OA:

  • Investigation:
  • xray shoulder, showing OA
  • imaging studies are essential to diagnosing degenerative joint disease
  • conventional xrays demonstrate shoulder osteoarthritis, with radiographic evidence of degenerative joint disease including:
  • joint space narrowing (mild)
  • osteophytes (small)
  • subchondral sclerosis
  • cysts
  • articular cartilage loss
  • axillary view provides best image to look for joint space narrowing and helps rule out complications
  • computed tomography arthrograms (CT scan, as image with a contrast agent) can localise articular defects
• Shoulder OA - Imaging and Differential Diagnosis pt1:

  • need to be very clear on subjective and objective to rule out differentials such as:
  • labral tears
  • septic arthritis
  • rotator cuff related shoulder pain
  • cervical disc disease with radiculopathy
  • frozen shoulder (adhesive capsulitis)
  • polymyalgia rheumatica (shoulder pain 95%)
  • pseudogout
  • systemic lupus erythematosus
  • biceps rupture or tendinopathy
  • cervical disc disease
  • cervical spondylosis
  • complex regional pain syndrome
  • shoulder pain in hemiplegia
  • thoracic outlet syndrome
  • osteochondritis dissecans
• Shoulder OA - Imaging and Differential Diagnosis pt2:

  • ask questions about other joints, if theyve had any recent infections to help rule out any autoimmune or potential rheumatic conditions
  • consider involvement of cervical spine to rule out any cervical involvement, ensuring theres no signs and symptoms related to a cervical radiculopathy e.g. as if theres any paraesthesia