Erkrankungen des Schultergelenks (Omarthrose)

Arthrosis in the shoulder may occur as omarthrosis (in the actual shoulder joint) and/or as AC joint arthrosis (acromioclavicular joint = shoulder joint between the shoulder blade and the clavicle). Arthrosis starts with the destruction of joint cartilage (the hard, elastic and smooth coating of bones in the area of joint surfaces). As the condition progresses, soft tissues (e.g. joint capsule, ligaments) and the bone may also become affected.
Initially, symptoms of omarthrosis are often not very noticeable. Nevertheless, the condition may progress rapidly, causing intense pain and significantly affecting mobility in everyday life.

Insufficient joint nourishment

Cartilage tissue does not have any nourishing blood vessels, but is supplied by synovial fluid. When stress is applied to the joint, the synovial fluid is squeezed out of the cartilage tissue – similar to a sponge – and drawn back in when the stress is removed.
However, when too much stress is applied to cartilage tissue, for example in the form of excessive pressure forces, its smooth surface is mechanically destroyed. The cartilage becomes frayed and is progressively depleted.


The most common causes are:
• Elevation of the brachial head at ruptured rotator cuff
• Accidents

Too little mechanical stress may also disrupt the nourishment of the cartilage. Inflammatory joint diseases (rheumatism) deteriorate the composition of synovial fluid.

Hard physical labour and repetitive strain are never the cause of the condition, but these factors accelerate its progression.

The symptoms listed below should make you consider your daily physical activities, to see if preventative measures need to be taken or if treatment may be necessary.

• A feeling of fatigue after longer walks is often the first indication of an existing condition. There is no pain yet, but you are increasingly feeling the need to take a break.
• The progressing joint degeneration eventually causes a pulling sensation, a feeling of pressure, mild pain in the groin area, thighs or knee joints.
• In the next phase, you will experience pain while walking longer distances, walking on uneven ground or while climbing stairs.
• Pain after periods of inactivity is a typical symptom: When standing up after long sitting or when getting up in the morning, your first few steps are often painful and you always feel initial stiffness.
• At later stages, you may experience resting pain and/ or night pain.
• The more pain you experience, the more you will try to avoid painful movements. As a consequence, your muscles become tense and shorten as you adopt an unnatural posture, continuously bending your hip and causing the joint capsule and ligaments to shrink. Ultimately, the range of motion of your hip joint decreases and movement becomes painful.

As coxarthrosis progresses, the changes in the hip joint also become visible in X-ray images.

• Initially, the joint cartilage is worn down. This cartilage is not directly visible in X-ray images, but it can be seen as a dark seam between the bright osseous joint parts, referred to as joint space (= permeable to X-rays). Representing the extent of cartilage damage, this joint space becomes increasingly smaller, until the two bones are ultimately touching each other.
• With increasing joint stress, the bone tissue also responds by thickening in the areas of overloading. X-ray images then show sclerosis (thickening) as a bright band (= impermeable to X-rays). The under-loaded part of the bone rather appears to be more transparent than usual.
• Osteophytes (bone spurs) increasingly occur on the joint’s surface area.
• In the areas of overloading, a loss of blood supply arises, the bone tissue dies and small cysts (cavities) form. They frequently appear in pairs opposite to each other on neighbouring bone parts.

During the thorough physical examination we ascertain and evaluate joint swellings, mobility, stability, pressure and pain during movement of the affected joint and the neighbouring joints, in addition to posture, misalignment of limbs and spine, nervous disorders, blood supply, height and weight.

The results usually yield a first diagnosis, which will then be confirmed, if necessary, using additional imaging techniques, and/or distinguished from similar signs and symptoms.

Physiotherapy:
Individualised physical therapy is combined with easy-to-understand instructions for self-treatment, to alleviate your discomfort, stabilise your cartilage and strengthen your muscles, helping you to significantly improve your mobility.

Additional Physical Therapy:
The usage of heat, cold, ultrasound or electrotherapy complements the treatment. These techniques promote blood flow and thus improve joint nourishment.

Antiphlogistics (anti-inflammatory medication):
Anti-inflammatory therapies, also referred to as antiphlogistics, are our first choice for all medical conditions of the musculoskeletal system. In addition to their anti-swelling and anti-inflammatory effect, their active ingredients also relieve pain in different strengths. The side effects of these medications particularly affect the stomach and kidneys (e.g. Ibuprofen, Diclofenac, Indometacin).

Cartilage-building supplements:
Gelatines, Chondroitin sulfate and glucosamine sulfate are supplements with scientifically proven efficacy. However, treatment over a period of six to twelve weeks is necessary to achieve the desired effect.

Pure analgesics (pain medication):
Pure analgesics do no treat the cause of arthrosis. Although they relieve pain, they have no effect on the inflammatory processes in the body (examples: (e.g. Paracetamol, Metamizol, Tramadol).

Your recovery is top priority

Rehabilitation (post-treatment) begins as early as on the date of the surgery. Especially in case of shoulder surgeries, it is decisive for the success of the surgery. In case of normal recovery course and good health constitution, you should expect a period of six week, depending on the type of the surgery. This also applies if you are already allowed to place full weight on the joint.

In order to ensure full recovery, we recommend that you undergo inpatient or outpatient rehabilitation after your stay at the hospital. We will be happy to assist you in choosing a facility and we will also take care of all the formalities with your insurance company.