INJECTION THERAPY FOR SHOULDER OSTEOARTHRITIS (OA)

What is shoulder osteoarthritis (OA)?

The shoulder (also known as the gleno-humeral joint) suffers from osteoarthritis (OA), which causes pain and limits movement. Mornings are usually the worst, although modest movement and exercise help. It may cause you to wake up in discomfort at night. Moving your arm out to the side and above your head aggravates the pain. Shoulder osteoarthritis is more common in those over 50, in women than in males, and in people who have a family history of the disease. A series of clinical tests and imaging are used to diagnose it. Osteoarthritis is best treated with physiotherapy, but if the pain is too severe to handle with exercise and/or is keeping you up at night, an ultrasound guided steroid injection is a highly effective therapeutic option for pain relief.

What are the symptoms of osteoarthritis of the shoulder?

The symptoms of osteoarthritis of the shoulder are:

  • Shoulder discomfort and stiffness are common, with achy pain deep in the joint.
  • Intermittent sharp pan movements with overhead movements, grinding, and audible cracking/clicking in the joint.
  • Morning pain is more intense, but it subsides with modest movement.

What conditions can be mistaken for osteoarthritis of the shoulder?

If this does not seem like your problem, there are a number of different disorders that can cause discomfort similar to osteoarthritis of the shoulder, including:

  1. acromio-clavicular (AC) joint osteoarthritis
  2. frozen shoulder
  3. shoulder impingement
  4. rotator cuff pain
  5. sub-acromial bursitis

Shoulder joint osteoarthritis (OA) vs Frozen shoulder

Shoulder osteoarthritis is more common in people over the age of 50 or 60, whereas frozen shoulder affects people between the ages of 40 and 60. Frozen shoulder is extremely uncommon in people over the age of 60, unless it occurs as a result of surgery or an accident. Both disorders cause movement restrictions and are frequently harsher at night and in the mornings. With a frozen shoulder, an X-ray is generally normal, whereas osteoarthritis is plainly visible on an X-ray.

Anatomy

The shoulder is made up of four joints that connect the upper limb to the body, two of which are typically impacted by osteoarthritis. These are the two joints in question:

  1. The glenohumeral joint is a joint in the upper arm. The ball-shaped end of the humerus (long bone of the upper arm) and a shallow dish (called the glenoid) on the shoulder blade form this joint (scapula). This articulation creates a ball and socket joint, which allows for a wide range of shoulder movements.
  2. The acromioclavicular joint is a junction between the acromion and the clavicle. This tiny joint connects the clavicle (collarbone) to the acromion and is found towards the tip of your shoulder (front aspect of the shoulder blade). Small, basic sliding movements are produced by this joint to alter the location of the shoulder blade during movement.
Acromioclavicular (AC) Joint Injuries injections treatment

The glenohumeral and acromioclavicular joints collaborate to stabilise the shoulder while also moving in synergy to produce a series of complicated and fluid arm movements. This is crucial to practically all of our daily actions.

A layer of articular cartilage protects the glenohumeral and acromioclavicular joint surfaces.

During arm movement, articular cartilage offers a friction-free surface for the joint and protects the underlying bone ends from harm. If either joint is put under stress, the protective layer thins out, and the thin layer of articular cartilage might become disturbed over time. Osteoarthritis is a degenerative joint disease that progresses over time.

Inflammation of the surrounding soft tissue and joint lubrication might result from repetitive motions of an osteoarthritic shoulder joint (synovium). Synovitis is the medical term for this inflammatory condition.

What causes shoulder osteoarthritis?

The actual reason for this is unknown. It is significantly less prevalent than osteoarthritis of the knee and hip. There are some risk factors that can put you at risk for osteoarthritis. These include:

  • Age – more often occurs in those > 50
  • Sex – more common in females
  • Family history – osteoarthritis can run in the family
  • Weight – a higher than normal body mass index (BMI) is associated with osteoarthritis in the shoulder
  • Previous trauma e.g. a previous fracture or dislocation of the shoulder. This is known as post-traumatic osteoarthritis
  • Certain occupations e.g. those involving heavy lifting such as construction work
  • Smoking – is linked to poor joint health
  • Age – more often occurs in those > 50
  • Sex – more common in females
  • Family history – osteoarthritis can run in the family
  • Weight – a higher than normal body mass index (BMI) is associated with osteoarthritis in the shoulder
  • Previous trauma e.g. a previous fracture or dislocation of the shoulder. This is known as post-traumatic osteoarthritis
  • Certain occupations e.g. those involving heavy lifting such as construction work
  • Smoking – is linked to poor joint health

What is the best way to tell if you have shoulder osteoarthritis?

Osteoarthritis symptoms begin with an intermittent severe discomfort in the shoulder, which is worsened by overhead tasks. Symptoms of osteoarthritis might grow more painful and frequent as the disease progresses. Symptoms might become chronic, interfering with everyday activities and causing you to wake up at night.

The following are some of the most common symptoms of shoulder osteoarthritis:

  • A dull agonising discomfort in the deepest part of the shoulder.
  • Sharp pains every now and again. These are frequently linked to synovitis in the joint.
  • During motions, there is a sensation of grinding or an audible clicking sound in the shoulder joint.
  • First thing in the morning, you have a limited range of motion and joint stiffness. With mobility, this is rapidly resolved. Shoulder mobility can become more pronounced as osteoarthritis advances, restricting overhead tasks.

How is osteoarthritis of the shoulder diagnosed?

It is recommended that you get expert guidance if you suspect you have osteoarthritis in your shoulder.

The first step in diagnosing shoulder joint osteoarthritis is to review your medical history and perform a series of strength and range of motion tests. A physiotherapist or an orthopaedic consultant can do this procedure.

osteoarthritis of the shoulder injection treatment

If your clinician believes you have osteoarthritis in your shoulder after conducting a clinical assessment, you may be referred for an x-ray. X-ray imaging has been used to diagnose bone and joint pathologies for decades, and it is particularly good at determining the existence and severity of osteoarthritis. A set of blood tests may also be requested. Blood tests are performed to rule out other diseases, such as rheumatoid arthritis-related systemic inflammation.

Although x-ray is a good tool for identifying osteoarthritis, it cannot detect the soft tissue inflammation that occurs with synovitis. Many people with shoulder osteoarthritis experience symptoms that are unrelated to the severity of the illness as detected on x-ray. This is frequently caused to synovitis within the shoulder joint, which is not visible on x-ray imaging.

Diagnostic musculoskeletal ultrasound imaging has been established in studies to be an excellent diagnostic tool for accurately assessing bone changes associated with osteoarthritis. It can also determine whether or not there is edoema and inflammation associated with synovitis (Kaeley el at, 2020). Synovitis is thought to be linked to disease progression and is typically responsible for the sudden spike of pain commonly observed in an osteoarthritic joint.

Joint injections has a team of highly skilled physiotherapists who are experts in assessing and diagnosing shoulder osteoarthritis. All of our musculoskeletal sonographers are properly qualified clinicians. You will be put through a battery of clinical examinations as well as a diagnostic musculoskeletal ultrasound scan during your initial evaluation.

How do we treat osteoarthritis of the shoulder pain?

The majority of people with osteoarthritis of the shoulder react effectively to conservative therapy. Over-the-counter pain relievers and a course of physiotherapy are common forms of conservative treatment. According to current research, the most essential components in the management of osteoarthritis are flexibility and strength (Gross et al, 2019). As a result, treatment regimens are designed to:

  • Increase your range of motion. This is accomplished by manipulating your shoulder joint with a combination of stretches and, on sometimes, manual therapy treatments.
  • Strengthening the muscles that surround the shoulder.

Here are a few exercises you might enjoy:

  • Reduce or eliminate activities that worsen your discomfort. This may entail taking frequent pauses or breaking down large work into smaller, more manageable chunks.
  • Begin a stretching routine for your shoulder joint. Stretching the shoulder joint by walking your fingers up a wall is a nice place to start. Before repeating the stretch, hold it for 30 seconds.
  • Gentle arm strengthening exercises are a good place to start.

Pain relief from arthritic joints can be achieved with over-the-counter medications like paracetamol or nonsteroidal anti-inflammatory gels like Voltarol. Before beginning therapy, talk to your pharmacist about the drug you’ll be taking.

injections for Shoulder osteoarthritis in UK

What if therapeutic approaches don’t work?

Conservative management does not always work to alleviate symptoms. There are different therapy choices available if this is the case. These will be described in more detail below.

Injection therapy

If your pain persists and is interfering with the following tasks, injectable therapy may be effective.

  • Pain that prevents you from sleeping or keeps you awake at night.
  • Pain that prevents you from performing daily actions such as cleaning and dressing, as well as participating in leisure activities.
  • Pain that is preventing you from participating in physiotherapy rehabilitation.

Injection therapy for shoulder osteoarthritis is commonly utilised and has been shown to be an effective treatment for lowering the discomfort associated with joint disease. An injection is given to relieve pain and inflammation while also providing a ‘window of opportunity’ for you to effectively rehabilitate your shoulder. A course of physiotherapy should be started within two weeks of obtaining a shoulder injection for the best outcomes.

According to recent studies, ultrasound-guided injections are more accurate in delivering medication to the target region and more successful in lowering pain and improving function than landmark-guided injections (Daniels et al, 2018).

All of our specialists at Joint Injections are properly qualified to give ultrasound-guided injections and have extensive expertise treating osteoarthritis of the shoulder. At Joint Injections, all injections are done under ultrasound guidance. The most effective reduction in your symptoms will come from using the highest degree of evidence-based treatment available.

What is injected during an osteoarthritis shoulder injection?

Two injectable approaches have been shown to be clinically helpful in lowering pain and improving function in patients with shoulder osteoarthritis.

Ultrasound-guided corticosteroid injection

A tiny dosage of corticosteroid medication (a potent anti-inflammatory substance commonly used in injectable therapy) is combined with a short-acting local anaesthetic during this procedure. This is then injected directly into the afflicted shoulder joint under ultrasound supervision. Corticosteroid is an excellent pain reliever that takes up to two weeks to acquire full effectiveness. As a result, it is recommended that you relax for a brief amount of time following the injection to allow the corticosteroid to take effect.

Ultrasound-guided hyaluronic acid injection

Hyaluronic acid is a synthetic version of the natural lubricant found in joints (synovial fluid). When injected into an osteoarthritic shoulder joint, hyaluronic acid has been shown to have anti-inflammatory and analgesic properties, and can provide pain relief (Colen et al, 2014). Hyaluronic acid injections are frequently utilised as a safe and effective alternative to steroid injections.