Shoulder

Glenohumeral Osteoarthritis

Glenohumeral osteoarthritis is progressive wearing of the cartilage that lines the ball-and-socket shoulder joint. While less common than hip or knee arthritis, it causes significant pain and stiffness that can profoundly limit daily function. At Maryland Orthopedic Specialists, we guide patients through the full treatment spectrum, from physical therapy and injections to shoulder replacement, to help restore comfortable, functional movement at every stage of the disease.

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In-network with most major insurance plans. Same-day appointments available for acute injuries.

What is glenohumeral osteoarthritis?

Glenohumeral (GH) osteoarthritis (OA) involves the degeneration of articular cartilage on the humeral head and/or glenoid surface, accompanied by subchondral sclerosis, osteophyte formation, and eventual loss of joint space. It is the third most common large-joint arthritis after the knee and hip.

Primary vs. Secondary Glenohumeral OA

Primary (idiopathic) OA occurs without a clear underlying cause and is typically a disease of aging.

Secondary GH OA develops as a consequence of:

Post-instability arthropathy: Repetitive anterior instability events cause cartilage damage from recurrent subluxation/dislocation
Post-fracture: Prior Severe trauma to the proximal humerus can lead to secondary Glenohumeral Osteoarthritis. Fracture in the glenoid can also cause arthritis.
Avascular necrosis, septic arthritis, or crystal deposition diseases

Posterior Glenoid Erosion and Walch Classification

A characteristic pattern of posterior glenoid erosion distinguishes GH OA from other shoulder conditions. The Walch classification describes glenoid morphology on axial CT imaging and guides implant selection:

Type A: Centered humeral head; A1 (minor central erosion) and A2 (major central erosion)
Type B: Posterior subluxation of the humeral head with posterior erosion; B1 (joint space narrowing), B2 (biconcave glenoid with posterior erosion), B3 (monoconvex posterior erosion)
Type C: Glenoid retroversion ≥ 25°, regardless of erosion
Type D: Glenoid anteversion or anterior humeral subluxation

Walch B2 and B3 glenoids pose the greatest reconstructive challenge and influence glenoid component choice in shoulder arthroplasty.

Symptoms — do you recognize these?

Deep, aching pain in the shoulder, worsened with activity and improved with rest
Morning stiffness lasting less than an hour
Loss of both active and passive shoulder motion (especially external rotation)
Audible or palpable crepitus (grinding) with shoulder movement
Pain with overhead reaching, cross-body maneuvers, and lying on the affected side
Gradual progression over months to years

Call us at (301) 515-0900. Same-day appointments available at our Bethesda and Germantown locations.

How we diagnose it

Physical Examination

Findings include global restriction of passive motion (capsular pattern), crepitus, and tenderness localized to the glenohumeral joint line (anterior and posterior). Rotator cuff strength should be formally tested, as concurrent cuff disease affects surgical planning.

Imaging

X-rays (AP in internal and external rotation, axillary lateral, Grashey view): Hallmarks include joint space narrowing, subchondral sclerosis, osteophyte formation (especially inferior humeral "goat beard" osteophyte), and humeral head flattening. The axillary view is essential for assessing posterior glenoid erosion and humeral head subluxation.
CT scan (with 3D reconstruction): Most accurate assessment of glenoid version, erosion pattern, and Walch classification; essential preoperative planning tool for arthroplasty.
MRI: Valuable for assessing rotator cuff integrity before surgical planning, particularly when arthroplasty is considered.

Treatment options

Treatment follows a stepwise ladder based on disease severity and patient functional demands.

Physical Therapy and Activity Modification

Early GH OA responds to a program focused on range-of-motion preservation, rotator cuff strengthening, and scapular stabilization. Activity modification to reduce repetitive overhead loading helps slow symptom progression.

Oral Anti-Inflammatories and Analgesics

NSAIDs reduce inflammatory pain and improve function in mild-to-moderate OA. Selective COX-2 inhibitors are appropriate for patients with GI risk factors.

Glenohumeral Injections

- Corticosteroid injections: Effective for moderate pain relief, particularly in inflammatory phases; benefits typically last weeks to a few months. Should be used judiciously due to negative effects on the rotator cuff from corticosteroids. - Platelet rich plasma (PRP): effective for reducing symptoms from Osteoarthritis

Surgical Procedure

Total Shoulder Arthroplasty (Anatomic)

Conventional anatomic shoulder replacement resurfacing the humeral head and glenoid with matched components to restore normal ball-and-socket anatomy for patients with glenohumeral arthritis and a functioning rotator cuff.

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Reverse Shoulder Arthroplasty

Shoulder replacement with reversed ball-and-socket geometry that allows the deltoid to power shoulder elevation when the rotator cuff is absent or irreparable. Performed for rotator cuff arthropathy, massive irreparable cuff tears, or failed prior replacement.

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Recovery & rehabilitation

Non-operative: Symptom management is the goal; disease progression is variable.
TSA: Outpatient or overnight hospitalization; sling 4–6 weeks; light activities at 6–8 weeks; full recovery 4–6 months. Most patients are highly satisfied, with >85% reporting significant pain relief.
RSA: Similar timeline; overhead function may be limited compared to anatomic TSA but deltoid-driven forward flexion is reliably restored.

Frequently Asked Questions

What is the difference between TSA and RSA?

Anatomic TSA mimics normal shoulder anatomy and is preferred when the rotator cuff is intact. Reverse TSA changes the biomechanics to compensate for a torn or dysfunctional rotator cuff. Our surgeons select the appropriate implant based on your specific anatomy, cuff status, and bone quality.

How long do shoulder replacements last?

Modern shoulder arthroplasty implants last 10–20 years or more in most patients. Glenoid component loosening is the most common long-term complication of anatomic TSA.

Can I delay surgery?

Yes. Surgery is elective and reserved for patients with pain and functional limitation that significantly impairs quality of life despite conservative care. We will work with you on non-surgical options as long as they remain effective.

What is the recovery timeline after shoulder replacement surgery?

After shoulder replacement, the arm is placed in a sling for four to six weeks to protect the repaired muscles and allow soft-tissue healing. Passive range-of-motion exercises begin within the first few days, and active use of the arm progressively increases over three to four months. Most patients achieve significant pain relief within the first few weeks and reach maximum functional improvement at six to twelve months. Return to light work or recreational activities typically occurs at three to four months, while overhead lifting and contact sports restrictions depend on the type of replacement performed.

What are the long-term outcomes after shoulder replacement for glenohumeral osteoarthritis?

Shoulder replacement for glenohumeral osteoarthritis has excellent long-term outcomes, with modern implants lasting 15 to 20 years in the majority of patients. Patient satisfaction rates exceed 90 percent, with dramatic improvements in pain, sleep, and shoulder function. The most common long-term concern with anatomic total shoulder replacement (TSA) is loosening of the glenoid (socket) component, which may require revision surgery after 15 or more years. At MOS we use careful pre-operative planning and implant selection to maximize implant longevity.