Diagnosis

Based on history and examination (see algorithm). The salient feature of glenohumeral joint stiffness is limitation of external rotation with the arm at the side. Other usual features of osteoarthritis (as with any joint) are pain, stiffness, crepitus. Incidence rises with age but should be considered as a possibility from 45 upwards.

Differential Diagnoses

• Adhesive Capsulitis (Frozen Shoulder)
• Impingement Syndrome and other rotator cuff disorders
• Calcific Tendinitis
• Neck pathology presenting as shoulder pain
• Shoulder Instability

• Combination of Trauma, Pain and Weakness should raise suspicion of Acute Cuff Tear
• Mass or swelling should raise suspicion of tumour
• Erythema, Fever should raise suspicion of infection
• Unexplained wasting, significant sensory or motor deficit
• Acute onset of pain and severe tenderness over the cuff

• Confirmed by plain radiograph: this will differentiate from frozen shoulder, avascular necrosis or dislocation of the shoulder, which may present with a similar clinical picture.

• Note that Ultrasound, MRI and CT scans are not useful diagnostic tests for shoulder OA.

Primary care management

The following interventions are suitable for administration in primary care (either by GP or physiotherapist):

• Symptomatic advice (rest, activity modification, heat packs)
• Analgesia/NSAIDs
• Landmark guided glenohumeral joint injection by an experienced practitioner
• Physical therapy.

Most patients will respond poorly to conservative treatment. Physical therapy may be of value in early arthritis (there is evidence for this in knee arthritis but not shoulder); pain relief from steroid injection typically lasts only 3-6 weeks.

Patients with Glenohumeral osteoarthritis, in whom severe and debilitating pain and/or functional limitation have persisted for more than 4 months despite the interventions listed above, can be considered for referral to secondary care.

Referral Instructions

Refer to Orthopaedics e-Referrals Service Selection

• Speciality: Orthopaedics
• Clinic type: Shoulder
• Service: DRSS-South Devon & Torbay-Orthopaedics-Shoulder & Elbow- Devon CCG - 15N

Referral Forms

Shoulder condition - PCT Referral form

DRSS referral form

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: December 2017