Shoulder arthritis. 3 ways to a pain-free shoulder.
- Mar 29
- 6 min read
Updated: 2 days ago
Joints can wear out over the course of a lifetime, either due to years of heavy strain or as a result of an accident. A genetic predisposition is also being discussed.
In this article you will learn:
This is what you need to know about cartilage.
What does osteoarthritis feel like and what can I do about it?
How long can I delay osteoarthritis and when is surgery advisable?
3 forms of therapy for cartilage damage and osteoarthritis.
What about sports after a cartilage transplant?
1. What you need to know about cartilage.
Cartilage acts as a buffer for our joints, absorbing stress. Depending on the type of joint, this layer can be up to 5 mm thick. In the shoulder, the average thickness per joint partner is between 2 and 4 mm. It is closely connected to the bone and, thanks to its water-retaining properties, acts as a shock absorber.
Cartilage absorbs the pressure and distributes it evenly across the joint bones.
Since there are only a few cells in the cartilage, metabolism and the associated cartilage formation are very slow.
Cartilage tissue is subject to constant renewal and remodeling processes, but in some cases the tissue is too weak to withstand the stress and cartilage damage can spread.
Cartilage consists of cartilage cells (chondrocytes) and the intercellular substance they form. The intercellular substance contains a high proportion of water, proteins, collagen, elastic connective tissue fibers, and hyaluronic acid.
Cartilage tissue is free of blood vessels and is nourished by diffusion, through the cartilage membrane and through the synovial fluid in the joint space.
There are three types of cartilage:
Hyaline cartilage exhibits high compressive elasticity and is found, among other things, in the shoulder joint as a covering over the humeral head and the glenoid cavity. Elastic cartilage, on the other hand, has a particularly high number of elastic fibers and is very flexible, thus forming, for example, the outer ear.
Fibrocartilage contains many collagen fibers and is the main component of the intervertebral discs and the joint lip in the shoulder (labrum).
A joint injury can cause cartilage damage. While cartilage damage refers to a localized change in the cartilage, osteoarthritis is a disease that affects the entire joint, including the bone.
This results in changes in the bone's adaptive responses due to a lack of cartilage tissue. This can lead to the formation of small cysts in the bone or bony protrusions (osteophytes).
In advanced cases, the cartilage is completely worn away, and you're essentially riding on the rim. Arthritis, on the other hand, describes joint inflammation that primarily affects the synovial membrane.
Various forms of arthritis (e.g. rheumatoid arthritis) also lead to changes in the cartilage and bone over time, which then take on the appearance of osteoarthritis.
2. What does osteoarthritis feel like and what can I do about it?
Typical for osteoarthritis is pain when moving, often initially after a long period of rest.
While the shoulder is still completely relaxed at rest, it hurts when you first turn out of bed in the morning. After moving the shoulder, the pain often subsides.
In cases of chronic cartilage damage, the mucous membrane of the shoulder joint is often permanently inflamed, feels warm, and the shoulder is swollen. Joint effusion and restricted movement are typical symptoms, with shoulder rotation being particularly affected.
Often the shoulder joint can no longer be rotated outwards or the hand cannot be moved backwards to put on a belt or fasten a bra.
However, protective postures can worsen the symptoms of osteoarthritis over time. In the later stages, the pain is often persistent, leading to increasingly limited movement, and even everyday activities become difficult or often impossible.
Since osteoarthritis is not an acute disease but a gradual process, there is no immediate "cure" but only measures to relieve the pain.
In the short term, painkillers or ointments can reduce symptoms; in most cases, the shoulder is inevitably protected to avoid painful movements.
If osteoarthritis pain persists for several weeks, it is advisable to consult a shoulder specialist.
How long can I delay osteoarthritis, and when is surgery advisable?
Each patient decides for themselves when to undergo surgery for osteoarthritis.
Osteoarthritis cannot be cured, but symptoms can often be alleviated through conservative measures and the problem can be postponed for a longer period of time.
During this time, physiotherapy and exercise play an important role, as they can maintain joint mobility and protect the muscles from rapid degeneration. This often allows people to live with osteoarthritis symptoms for quite some time.
Taking dietary supplements is not harmful, but their benefits are controversial. Cartilage cell regeneration can be performed in cases of isolated cartilage damage, but they are of no use in cases of severe osteoarthritis.
Even minor procedures (arthroscopic debridement) can temporarily extend the lifespan of someone with osteoarthritis. However, osteoarthritis is incurable, and in advanced stages with significant limitations, patients often want to regain their quality of life. In many cases, a worn-out joint can be replaced with an artificial joint.
In order to use joints that are as small as possible and save bone, you should not wait too long to see an orthopedist.
In order not to miss the best time for an artificial joint, X-rays at annual intervals can help to assess the dynamics.
4. 3 forms of therapy for cartilage damage and osteoarthritis.
In the treatment of cartilage damage and osteoarthritis, a variety of therapy options are used, individually tailored to the patient.
In addition to maintaining mobility, e.g. through physiotherapy, there are some specific forms of therapy with the aim of protecting or building up cartilage tissue or delaying or treating osteoarthritis.
Treatment methods are individually tailored to the patient. Orthoses, for example, can help temporarily improve the position of the humeral head in the glenoid cavity in cases of shoulder instability.
A common procedure is injection therapy, which involves injecting various preparations into the shoulder joint. One of these is hyaluronic acid.
Hyaluronic acid is a substance found in various organs of the body, such as the skin, eyes, and joints. In joints, hyaluronic acid ensures good lubrication of the synovial fluid.
This can mitigate superficial cartilage breaks and re-lubricate the joints to reduce irritation and thus fluid accumulation and swelling.
In addition, so-called autologous blood therapy for joints has existed for several years.
This involves centrifuging blood taken from the patient's own body and then injecting special blood components (ACP = autologous conditioned plasma) into the shoulder joint. While ACP therapy has been successfully used for sports injuries (tendons, muscles, ligaments), its effectiveness in treating cartilage damage and joint wear is not yet proven.
One advantage of ACP is that it is administered into the joint without additives and its effect is achieved purely through the release of the body's own growth factors.
However, treatment with hyaluronic acid and ACP is not covered by statutory health insurance. Isolated cartilage damage can also be repaired surgically, preventing it from spreading to the entire joint.
Microfracture can stimulate the formation of the body's own replacement cartilage at the damaged site. This can be additionally supported by a special matrix applied to the affected area (AMIC).
In contrast, there are procedures in which cartilage cells (chondrocyte transplantation) or whole cartilage-bone tissue (OATS) are removed from a non-load-bearing area of the joint and transplanted to the site of the cartilage defect. In cases of large cartilage defects and already established osteoarthritis, cartilage cells cannot yet be transplanted in a targeted manner.
Especially in young athletic patients with early osteoarthritis, e.g., after a sports accident with cartilage defect, we can now perform a minimally invasive partial joint surface replacement that replaces the damaged cartilage surface without having to insert a complete prosthesis.
In some cases, problems caused by joint wear can be "modeled" with bone correction, i.e. debridement.
If all these measures have been unsuccessful, the quality of life and the function of the shoulder are severely limited and the overall level of suffering is very high, an artificial shoulder joint should be considered.
5. What about sports after a cartilage transplant?
After a shoulder cartilage transplant, the implanted cartilage cells need time to bond with the surrounding tissue. Therefore, we advise against sporting activities involving high shear stress on the shoulder joint (e.g., rowing) for 6 months.
On the other hand, you can start exercising primarily on the lower body after about eight weeks. Ask our specialist how this works for your favorite sport!
Conclusion:
Cartilage acts as a buffer for our joints and absorbs stress. In the shoulder, it is approximately 2-4 mm thick.
Cartilage consists of cartilage cells (chondrocytes) and the intercellular substance they form. The intercellular substance contains a high proportion of water, proteins, collagen, elastic connective tissue fibers, and hyaluronic acid.
Typical for osteoarthritis is pain when moving, initially after a long period of rest.
In the short term, painkillers or ointments can reduce the symptoms, but in most cases the shoulder is inevitably protected and a painful movement disorder results.
In the treatment of cartilage damage and osteoarthritis, a variety of therapeutic procedures are used, individually tailored to the patient.
Do you have questions about cartilage cell therapy or osteoarthritis?
Then make an appointment with our specialist :
Specialist in orthopedics
and trauma surgery,
Sports medicine
