Degenerative

Glenohumeral Osteoarthritis

Osteoarthritis of the glenohumeral joint. Concentric (without cuff tear) or eccentric (with massive cuff tear).

Glenohumeral osteoarthritis is osteoarthritis of the glenohumeral joint. It is less common than knee or hip osteoarthritis due to the low weight-bearing nature of the shoulder. It is classified as concentric (humeral head centered on the glenoid, rotator cuff intact) or eccentric (humeral head migration superiorly due to massive rotator cuff tear). Primary glenohumeral osteoarthritis is rare; it is most often secondary to trauma, chronic instability, avascular necrosis, or inflammatory arthritis. Conservative treatment (physiotherapy, injections) is effective in early stages. Anatomical total shoulder replacement (concentric) or reverse replacement (eccentric) is indicated in advanced disabling forms.

Characteristics

  • Progressive shoulder pain with activity, morning stiffness (< 30 min vs > 1h in inflammatory arthritis), progressive loss of mobility. Palpable and audible crepitus.
  • Progressive decrease in range of motion: external rotation (first affected), then flexion and abduction. Loss of strength due to pain inhibition.
  • Radiographs: glenohumeral joint space narrowing, marginal osteophytes (humeral head and glenoid), subchondral sclerosis, geodes. Samilson-Prieto classification in 3 stages.
  • Eccentric osteoarthritis: superior humeral head migration under the acromion due to massive rotator cuff tear. Cuff tear arthropathy. Reverse replacement indication (Grammont concept).

Medical and surgical management

  • Early stages: conservative treatment. Physiotherapy, NSAIDs, intra-articular injections (corticosteroids, hyaluronic acid). PRP under evaluation.
  • Disabling concentric osteoarthritis: anatomical total shoulder replacement (humeral resurfacing + glenoid component). Excellent functional results (90% satisfaction at 10 years).
  • Eccentric osteoarthritis (massive cuff tear): reverse replacement (Grammont concept — medialization of center of rotation, deltoid recruitment). Good functional results with significant improvement in pain and mobility.

Physiotherapy rehabilitation

  • Gentle mobilization to maintain range of motion. Joint distraction techniques. Daily self-mobilization (pendular, stick).
  • Adapted muscle strengthening: rotator work with light loads, deltoid, scapular stabilizers. Pain-free range exercises.
  • Pain relief techniques: heat (paraffin, thermotherapy), TENS, post-exercise cryotherapy. Warm balneotherapy (34-36°C).
  • Post-operative shoulder replacement: specific rehabilitation depending on replacement type (anatomical vs reverse). Early passive then active-assisted mobilization. Recovery over 6-12 months.

Classification

  1. Stage I — Early

    Moderate joint space narrowing, early osteophytes. Conservative treatment.

  2. Stage II — Moderate

    Significant narrowing, marked inferior osteophytes. Physiotherapy + injections.

  3. Stage III — Severe

    Advanced joint destruction. Shoulder replacement indicated if conservative treatment insufficient.

  4. Stage IV — Very severe

    Advanced joint destruction. Shoulder prosthesis indicated if conservative treatment is insufficient.

Average duration

8 to 24 weeks post-operative

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Scientific sources

General information only: this content cannot provide a diagnosis or prescription. A healthcare professional must assess your situation.