Shoulder Osteoarthritis

The prevalence of shoulder complaints in the UK is estimated to be 14%, with 1-2% of adults over 45 consulting their general practitioner annually with a new problem. Shoulder arthritis is the cause of pain in 2-5% of this group. (ref: BESS/BOA care pathways)

Key Messages

Community based treatments including analgesia, landmark guided injection and physiotherapy are the mainstay of treatment for most shoulder conditions.

Scope

Adults in primary care with glenohumeral osteoarthritis

Out of scope

Patients without glenohumeral osteoarthritis

Assessment

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

Red Flags

  • 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

Investigations

  • 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.

Management

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

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


Supporting Information

Pathway Group

This guideline has been signed off by South Devon and Torbay CCG.

Publication date: December 2017

 

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