Shoulder Osteoarthritis

Degenerative disease of the glenohumeral joint. Primary (idiopathic) OA is less typical here than at the hip, knee or hand — shoulder OA is more often secondary: post-traumatic (after dislocation or fracture), crystal arthropathy, rotator-cuff (cuff-tear) arthropathy, or Charcot arthropathy.

• Epidemiology: increases with age (typically >70); more common in women and after anterior dislocation.
• History: progressive shoulder pain over years, worse with activity, little pain at rest.
• Examination: loss of ROM (especially external rotation), crepitus, catching.
• Investigations: X-ray — joint-space narrowing, subchondral sclerosis and cysts, osteophytes.
• Management (per the RACGP OA guideline): education, exercise and weight management first; analgesia (paracetamol, topical then oral NSAIDs); intra-articular corticosteroid for short-term relief; arthroplasty for disease refractory to non-operative care.

The RACGP guideline covers the knee and hip, not the shoulder, so its recommendations are applied here by analogy. Two carry across most safely because they are the guideline’s only strong recommendations for an intervention: exercise, and weight management with a minimum 5–7.5% target in anyone overweight or obese. Corticosteroid injection gives short-term relief but repeated injections carry potential harm. Oral and transdermal opioids are strongly recommended against; so are glucosamine and chondroitin.