What exactly is omarthrosis?

Omarthrosis is a type of osteoarthritis that affects the shoulder joint. The word is made up of the Greek word ὦμος („omos“) for shoulder and the word arthrosis for joint wear and tear. A distinction is made between osteoarthritis caused by age and osteoarthritis caused by accident or disease. For example, people who dislocate their shoulder a lot are more likely to develop osteoarthritis later in life.

In general, the likelihood of shoulder wear and tear increases with age, and not just in people who have been exposed to heavy physical strain. This cartilage wear – which usually affects the humeral head and socket – is usually painful. It leads to immobility of the shoulder.

Defective arthropathy is a special case. In this case, an injury or wear to the rotator cuff leads to significant to severe restrictions in shoulder mobility. As a result of the decentration of the humeral head, arthrotic changes in the shoulder joint often occur.

What symptoms should you look out for?

Pain in the shoulder, especially when lifting the arm, and increasing restriction of movement in the shoulder are clear signs of wear and tear in the shoulder joint. The pain usually comes from the front. Occasionally, there may be a crepitus in the joint. Other symptoms include tenderness when lying down or sleeping, and pain when the arm is rotated or abducted. Pain in the neck or cervical spine (cervical spine syndrome) may also indicate omarthrosis. A doctor should always be consulted if there is persistent, unexplained pain in the shoulder.

How is osteoarthritis of the shoulder clinically diagnosed?

Omarthrosis is diagnosed clinically by a specialist. The diagnosis is made on the basis of the patient’s medical history (anamnesis), a physical examination and modern imaging techniques. All three are important components of the diagnosis: the medical history not only serves to establish the diagnosis, but can also be part of the treatment for many patients. In this context, the patient can describe their symptoms and experience significant relief. The doctor also examines the shoulder for pain, swelling and mobility. Imaging procedures such as ultrasound (sonography), X-rays and magnetic resonance imaging (MRI) are used specifically to obtain precise information about the bony structures and soft tissue.

X-rays, in particular, can help determine the degree of osteoarthritis and rule out other possible causes of pain. Magnetic resonance imaging (MRI) can help assess the condition of the cartilage and soft tissues in the shoulder. Computed tomography (CT) or digital volume tomography (DVT) provides a three-dimensional view of the bones involved, which is important when planning surgical treatment.

Is there a conservative treatment for osteoarthritis?

Omarthrosis can be treated conservatively. This includes physiotherapy, painkillers, injections of cortisone or hyaluronic acid, and other anti-inflammatory treatments.

The aim is to relieve pain and improve mobility in the shoulder joint. It is therefore important to see a doctor in good time: If omarthrosis is diagnosed at an early stage, in many cases it can be treated by a shoulder specialist to preserve the joint. Surgery is only considered if conservative treatment does not bring sufficient improvement.

Is surgery necessary, yes or no?

In advanced cases, surgery is usually unavoidable. Our shoulder specialists have a range of minimally invasive surgical techniques (MIS) at their disposal. Arthroscopy can be used both diagnostically and therapeutically to treat degenerative changes. This includes a range of cartilage therapies.

Total shoulder arthroplasty (TPA) can restore mobility to the shoulder joint in people with severe arthritis. The aim of the implant is to enable the patient to lead a pain-free life again and to allow the shoulder joint to move freely.

We use different types of joint replacement: We make sure that these are tailored to the individual patient and that they are fully informed about the benefits, consequences and risks of the procedure. Get in touch with us. We specialise in shoulder replacements and can tell you more about how the material works, how long it will last and how to proceed.

What happens after surgery (post-op)? What will everyday life be like with a shoulder replacement?

Firstly, rehabilitation depends on a number of factors, such as the patient’s age, the condition of the shoulder joint before surgery, the treatment method and the degree of wear and tear on the joint. Depending on the individual situation, rehabilitation may take place on an outpatient or inpatient basis for a few weeks, followed by physiotherapy. After surgery, it is important to protect the shoulder joint and to do gentle but regular exercises (mobilisation, strengthening). This will improve mobility and help the healing process. A healthy lifestyle is especially important after surgery.

What is shoulder tightness syndrome?

Shoulder tightness syndrome is an anatomical tightness under the acromion with frequent accompanying inflammation of a bursa (bursitis subacromialis). The space between the humeral head and the acromion is crossed by the tendons of the rotator cuff. The constriction causes mechanical friction and even bruising of the tendons, for example when lifting or rotating the arm. A spur-like protrusion at the lower anterior edge of the acromion/acromion is often responsible for this. The so-called impingement situation, which causes the resulting tightness, often leads to inflammation with night pain and, in the course of time, also to restricted movement. If the shoulder tightness syndrome persists for a long time, the rotator cuff tendons – especially the supraspinatus tendon – can be mechanically damaged and also tear.

How to diagnose shoulder impingement?

To diagnose imgingement of the shoulder, an ultrasound and / or magnetic resonance imaging is performed in addition to the medical history and a clinical examination. In the early stages of the disease, the degree of discomfort can be temporarily alleviated by injection treatment (by means of an injection) under the acromion.

What is the best way to treat shoulder impingement?

Therapeutically, arthroscopy / minimally invasive surgery is therefore recommended. In this procedure, the inflamed tissue (bursa) is removed, as well as the bony spur. The bony spur is removed by means of a bone cutter. If necessary, a tendon suture can also be performed if appropriate damage has already occurred.

What is AC joint arthrosis?

AC joint arthrosis is a painful swelling of the acromioclavicular joint. In the course of time, cartilage is reduced and thus – similar to the hip or knee joint – arthrosis occurs. The resulting friction between two unprotected bones leads to pain. In addition to joint swelling, osteoporosis is often accompanied by bone spurs, so-called osteopaths.Some of these can already be inspected, provided they grow upwards towards the skin mantle. Frequently, nose-like spur formations occur downwards towards the rotator cuff tendons, so that a bottleneck syndrome/impingement also develops here.

How can AC joint arthrosis be treated?

Therapeutically, the bony spurs can be removed by arthroscopy / minimally invasive surgery. In addition – depending on the severity of the arthrosis – an abrasion of the lateral joint forming part of the clavicle is carried out.

What is an acromioclavicular joint dislocation?

An acromioclavicular joint dislocation is a strain or sprain of the shoulder joint and the ligaments in the shoulder girdle.
It is also known as shoulder dislocation and is caused mainly by external factors (such as an accident, fall and other external influences). In most cases it is a sports injury. This results in varying degrees of damage to the capsule and ligaments, which can be classified with the help of a medical diagnosis and treated accordingly.

What does AC stand for?

AC is the abbreviation for the acrominoclavicular joint, which connects the clavicle to the acromion.

What are the typical symptoms?

These include acute pain, swelling, bruising and bulging of the affected area. People often adopt a protective posture because the shoulder can no longer be fully moved or loaded. The so-called „piano key sign“ is also typical: if the elevated clavicle is pressed down, it automatically springs back up when released. In this way, an acromioclavicular joint dislocation can often be seen with the naked eye. A medical diagnosis will give further information about the severity of the injury.

What is diagnosed?

A number of tests are used to determine whether the injury is a simple strain, a tear or, in the worst case, a complete separation of the ACL ligaments. In addition to a physical examination (including testing for tenderness, functional limitations, or malalignment), x-rays can help make a more accurate diagnosis.

What are the treatment options?

Depending on the findings, the treatment options (conservative/surgical) will be tailored accordingly. A mild dislocation can be treated by immobilising the shoulder. Physiotherapy or cryotherapy may also help the healing process. However, if the tear is more serious, surgery will be required to stabilise the shoulder.

What is a rotator cuff?

Mehrere Muskeln und Sehnen bilden die Rotatorenmanschette, welche das komplette Schultergelenk stabilisieren und für entsprechende Beweglichkeit des Armes sorgen.

What is the best way to treat a tendon rupture?

If a tendon tear of the so-called rotator cuff occurs in the shoulder area, for example caused by an accident or also due to wear and tear, these can be refixed within the first three months as part of an arthroscopy and with the help of a special suture anchor system. Subsequently, immobilization in a shoulder abduction cushion is required. Furthermore, mobility is restored within the framework of physiotherapeutic exercise therapy.

What is special about the biceps (brachii) muscle?

The biceps is the two-headed muscle in the upper arm (also called the arm flexor) responsible for bending the forearm. The two tendons are different lengths and originate from the elbow joint. If one of the tendons tears, it is called a biceps tendon rupture.

What is the best treatment for a torn biceps tendon?

Injuries to the biceps tendon, which is attached to the labrum in the shoulder joint, can be treated differently depending on the type of injury. For younger patients who are generally active in sports, detachment of the biceps tendon anchor is recommended if there is a corresponding slap lesion. The detached biceps tendon is then refixed further out in what is known as the bicipital sulcus using a special anchoring system to restore function.

Due to the fact that the biceps tendon muscle has two tendon insertions in the shoulder region, it is recommended that the long biceps tendon be detached at the anchor without reattachment in older patients. The tendon will then slide out of the joint and no longer cause interference or instability. It will then grow into the bicipital sulcus and the tension function will be provided by the remaining short biceps tendon.

How do you recognise shoulder instability?

Shoulder instability can be congenital (habitual) or caused by an accident with dislocation of the humeral head from the socket (traumatic). This often results in injuries to the so-called labrum and the acetabular bone.

What is important in the diagnosis?

In individual cases, the consequences of the injury must be objectified, for example by sonography (ultrasound), magnetic resonance imaging and, in the case of bony involvement, by CT diagnostics.

What treatment is recommended?

In young, athletically active patients, surgical stabilisation is recommended if there is evidence of labral injury or concomitant rotator cuff injury. In older patients with a traumatic initial dislocation, a conservative approach without surgery may be used initially. However, surgical stabilisation is also recommended in the event of recurrent dislocation. In the case of habitual shoulder instability, appropriate treatment must be initiated on an individual basis, depending on the severity of the findings.

When is surgery necessary?

Depending on the severity of the injury, the frequency of dislocation and any previous surgery, the appropriate procedure will be discussed with the patient. Several minimally invasive procedures are used, such as arthroscopic Bankart refixation and Latarjet coracoid tendon transfer. In revision cases, it may be advisable to move the bone block.

What is a shoulder fracture?

The term fracture means a break in the bone. A distinction is made between different forms of fracture. The bone can be partially or completely broken. External influences are usually the cause, such as a fall or impact.

What are the conservative / surgical treatments?

In the case of fractures of the humeral head or clavicle, depending on the displacement of the bony parts, either a non-operative, i.e. conservative or operative therapy is initiated. For this purpose, in addition to the X-ray examination, a computed tomographic clarification of the situation is often necessary in order to offer the appropriate and individually tailored therapy to the patient.

What is a frozen shoulder?

Frozen shoulder is a disease that occurs in three stages: 1) First, inflammation occurs in the shoulder. 2) In the further course, the affected person notices an increasing restriction of movement (therefore also called „freezing“). 3) In the further course, appropriate therapy can help to reduce the inflammation and improve mobility („onset of freezing“).

What are the symptoms of those affected?

Patients often suffer from constant pain, which also occurs at night and disturbs sleep. As a result, people tend to lie on one side, which puts additional strain on the shoulder. Imaging techniques such as sonography (ultrasound), x-rays and magnetic resonance imaging (MRI) are needed to diagnose the condition.

Patients also find it difficult to move their arm because of the pain, so the capsule shrinks and a frozen shoulder develops.

What are the treatment options?

Initial treatment with anti-inflammatory drugs and often cortisone (in the form of injections or tablets) is necessary at an early stage. Once the acute pain has subsided, physiotherapy and exercise are recommended.

If necessary, surgery can help with frozen shoulder. This involves arthroscopy to remove inflamed tissue and loosen adhesions. Any anaesthesia will be followed by mobilisation, which may be followed by intensive physiotherapy.

What does the therapy depend on?

A classification (Tossy/Rockwood) is used to determine the severity of the shoulder injury. The classification then determines the appropriate therapy required for the injury. The following three types are distinguished.

Tossy/ Rockwood I – The AC joint is compressed, the capsule is overstretched. The bones, especially the clavicle, do not move under load. Conservative therapy is used.

Tossy/Rockwood II – This is a partial tear of the joint capsule and the acromioklavicular ligaments. This stage can also be treated conservatively.

Tossy/Rockwood III – Complete rupture of the capsule and ligaments with horizontal and vertical instability. Because the coracoclavicular ligaments are completely torn, the clavicle is significantly higher than the acromion. Successful treatment can only be achieved through surgery.

What is a calcific tendinitis?

Calcific tendinitis (tendinitis calcarea) occurs when a calcium deposit builds up in the tendon (attachment to the rotator cuff) of the upper arm. It is often a gradual process that can be divided into several phases:

• Cell transformation – during this process the tendon tissue transforms into so-called fibrocartilage, which, however, still causes my pain
• Calcification – as the cartilage partially dies, calcium forms. This can already be detected by imaging. This leads to constriction in the acromion (shoulder roof), so that the tendon becomes increasingly irritated
• Resorption – an inflammatory reaction of the tendons and bursa (bursitis) follows due to resorption, which is now reponsible for severe pain in the upper arm

What is the cause of tendinitis?

The cause of tendinitis is not known. Middle-aged women in particular are affected, and calcific tendinitis manifests itself as a stabbing pain that worsens when the patient is lying down. Lifting the arm also becomes increasingly problematic to no longer possible and in some cases a thickening of the tendon is noticeable.

Using imaging techniques, calcified shoulder can be diagnosed and differentiated from other possible conditions such as osteoarthritis or tendon rupture. A calcified shoulder can be treated both conservatively and surgically. Conservative treatment methods include local injections and physiotherapeutic exercises.

How to treat calcified shoulder surgically?

If there is no improvement after prolonged use, arthroscopy (joint endoscopy) is recommended. With the help of minimally invasive surgery, calcium deposits can be removed extensively, without damaging the joints or the tissue. This therapy allows a return to the usual active daily life in only a few weeks. Immobilization of the arm is not necessary; on the contrary, physiotherapy leads to a faster recovery.

What arthroscopic procedures are available?

Depending on the type and severity of the condition, different arthroscopic procedures can be performed on the shoulder. These include removal of diseased tissue (for example, subacromial decompression), rotator cuff repair, labral tears following sports injury (Bankart and SLAP lesions), capsular reconstruction and long biceps tendon pathology.

What happens during a shoulder arthroscopy?

Shoulder arthroscopy, also known as shoulder endoscopy, is a minimally invasive surgical procedure. It allows the shoulder surgeon to access the painful shoulder joint through a few small incisions of just 5-10 mm to investigate the cause of the shoulder pain. It can help diagnose and treat shoulder problems.

How long does it take to recover from shoulder arthroscopy?

The length of recovery after shoulder arthroscopy depends on the type of procedure. For simple procedures, the joint is usually back to normal immediately. Complex rotator cuff surgery can take several months before full function is restored.

What is a shoulder endoprosthesis / replacement?

A shoulder replacement is an artificial shoulder joint that replaces the damaged joint surfaces of the shoulder. Total shoulder arthroplasty (TSA) or partial shoulder arthroplasty (hemiprosthesis) may be used, depending on the extent and location of damage to the shoulder and rotator cuff.

When is a replacement necessary?

Shoulder replacement surgery may be considered when conservative and non-operative treatment of the shoulder joint has failed. In particular, when degenerative conditions of the shoulder joint (such as osteoarthritis) are advanced and cause severe pain and limited range of motion, shoulder replacement may provide relief. Shoulder replacement is a surgical procedure and should be performed by experienced shoulder specialists.

What is the difference between a total shoulder replacement and a shoulder hemiprosthesis?

The difference between a total shoulder replacement (or total shoulder arthroplasty (TSA) as it is also known) and a hemiprosthesis lies in the type of joint replacement. A hemiprosthesis replaces only the head of the humerus, whereas a total shoulder replacement replaces both the head of the humerus and the glenoid cavity with an artificial implant.

Whether a total shoulder replacement or a partial shoulder replacement (hemiprosthesis) is used depends on the extent and location of damage to the shoulder and rotator cuff. This is discussed with the patient during an individual consultation and the appropriate therapy is determined.

What is an inverse endoprosthesis?

An inverse endoprosthesis is increasingly being considered, particularly for rotator cuff defects. Unlike an anatomical shoulder replacement, which cannot satisfactorily solve the problem of a missing rotator cuff, an inverse shoulder replacement optimises the function of the deltoid muscle by altering the biomechanics of the joint. This allows it to take over the function of the rotator cuff.

The inverse prosthesis is also often a suitable implant for fresh or unhealed humeral head fractures and bone tumors.

How long does it take to heal after shoulder replacement surgery?

This depends on the type of shoulder surgery. Aftercare (rehabilitation), which lasts about 3 to 6 months, plays a crucial role. In particular, exercises to strengthen the shoulder muscles should be carried out over a longer period of time.

On average, you will be able to resume everyday activities 6 to 8 weeks after the operation. Overhead work, bringing the hand to the mouth and personal hygiene such as combing and brushing the teeth are almost pain-free after the operation.

How long does a shoulder replacement last?

The average lifespan of an implanted shoulder replacement is more than 15 years, depending on the material used and the level of daily activity.

What is a shoulder revision?

The surgical replacement of a shoulder prosthesis that has already been implanted is called a shoulder revision. A shoulder prosthesis needs to be replaced if it has become defective, loose, infected or dislocated.

A distinction is made between single-stage and two-stage shoulder replacement: in a single-stage replacement, a new prosthesis is implanted immediately after the old prosthesis is removed; in a two-stage replacement, a placeholder is implanted first, which is replaced by a new shoulder prosthesis after about 6 weeks. The two-stage replacement is the proven procedure, especially in the case of an infected joint.

Why does a shoulder prosthesis need to be replaced?

The most common reason for replacing a shoulder prosthesis is that the prosthesis or parts of the prosthesis have become loose. This can be caused by changes in the body’s own bone tissue, wear and tear, or long-term material fatigue.

Another reason for revision is age-related damage to the rotator cuff in total shoulder arthroplasty (TSA). Modern implant systems make it possible to switch to a reverse prosthesis without having to remove the implant completely.

In some cases, a shoulder prosthesis can become loose several months to years after implantation, for example due to infection of the artificial shoulder joint, fractures after a fall or prosthesis dislocation. Modern imaging techniques (e.g. X-ray, CT) of the shoulder can provide more accurate information.