Shoulder Osteoarthritis Treatment London | Private Ultrasound Diagnosis & Injections

Shoulder Arthritis Explained

Basic Shoulder Joint Anatomy

Shoulder osteoarthritis refers to degenerative changes to the main articulation of the shoulder, known as the glenohumeral joint. The glenohumeral joint is formed by a flat, small socket at the lateral end of the shoulder blade, known as the glenoid, and the upper arm articulates with this socket via a ball-shaped structure called the humeral head.

The shoulder normally has a significant range of motion, allowing us to place our hands above our head, behind our back, and out to the side.

Symptoms of Shoulder Osteoarthritis

The main symptom of shoulder osteoarthritis is that these movements become restricted in their range of motion, and the joint becomes stiff and painful during movement.

In more severe cases of shoulder osteoarthritis, resting pain may develop in the shoulder, along with a significant nocturnal pain pattern, which may radiate into the upper arm.

Causes of Shoulder Osteoarthritis

Shoulder osteoarthritis is not as common as osteoarthritis in the hips or knees, for example. Often, individuals who suffer from shoulder osteoarthritis have experienced a previous injury that altered the anatomy of the joint earlier in life.

Dislocations of the shoulder joint and fractures of the humeral head or glenoid are all common examples of injuries that can accelerate degenerative changes in the shoulder joint seen in clinical practice.

Diagnosing Shoulder Osteoarthritis

An ultrasound scan is an excellent method for demonstrating the normal bony anatomy of the glenoid and humeral head at the posterior aspect of the joint.

In this view, we can also assess whether the shoulder has any significant effusion, swelling, or fluid emanating from the joint, and we can exclude other factors such as tears or ruptures of the rotator cuff tendons.

Ultrasound Guided Injections for Shoulder Arthritis

Glenohumeral Joint Ultrasound Guided Injections to Treat Shoulder Osteoarthritis

An ultrasound-guided injection to the glenohumeral shoulder joint can be an effective treatment to help manage the symptoms of moderate to severe shoulder osteoarthritis.

This procedure is performed by placing the ultrasound probe so that the glenoid and humeral head are visualised at either end of the ultrasound image. The needle can then be visualised passing underneath the shoulder capsule to the posterior humeral head, and the injectate can be seen flowing into the glenohumeral joint.

This injection is commonly administered with the patient in a side-lying position when approaching the injection from medial to lateral, or in sitting or side-lying position when approaching the injection from lateral to medial — both of which are sound techniques.

What to Do After Your Shoulder Arthritis Injection

Needle Path & Post-Injection Pain
The shoulder glenohumeral joint is a relatively deep structure, and in most individuals, the needle path does not cause significant trauma. We typically access the joint from the posterior (back) aspect of the shoulder.
Because of this approach, post-injection pain directly related to the needle is uncommon.
However, in some cases of steroid or hyaluronic acid injections, the joint may become painful due to a post-injection flare. This is believed to occur because the medication and injectate react with the synovial fluid in your joint.
If this occurs, over-the-counter painkillers (as directed on the patient information leaflet) can be taken.

Wound Care & Infection Risk
Avoid exposing the needle site to public or dirty water (e.g., swimming pools, hot tubs, lakes) for 2–3 days after any ultrasound-guided injection, due to the small infection risk.

Activity Guidance
After a shoulder arthritis injection, it is advisable to avoid any significant increase in activity for 10 days.
This allows the anti-inflammatory properties of the steroid to work optimally.
Following this period, you should engage in a progressive program of physical therapy exercises but should not push the shoulder into any significant pain.

Follow-Up
Following an injection for shoulder arthritis, please contact me immediately if you experience any difficulties.

Other Treatments for Shoulder Osteoarthritis

Mobility Exercises for Shoulder Glenohumeral Joint Arthritis

Strengthening Exercises for Shoulder Glenohumeral Joint Arthritis

Advanced Strengthening Exercises for Shoulder Glenohumeral Joint Arthritis

Surgery for AC Joint pain

Diagnostic ultrasound has become the gold standard for many common musculoskeletal shoulder pain conditions. Due to the ability to visualize small defects in tendons, underlying bony attachment of tendons and the ability to stretch and load specific structures of the shoulder due to the range of motion available, A shoulder ultrasound scan is able to define small changes  including:

• Areas of rotator cuff tendinopathy

• rotator cuff tears,  location  and precise measurements

• distention and thickening to this subacromial bursa

• Thickening to the ligaments of the rotator interval,  common in frozen shoulder

• long head of biceps tenosynovitis and tears

• AC joint arthritic changes

• Shoulder (glenohumeral) joint  arthritic changes and joint effusion 

AC Joint Pain | Evidence base

The evidence for shoulder osteoarthritis supports a structured, tiered management approach beginning with non-operative treatment. Physiotherapy focuses on maintaining range of motion (especially external rotation and elevation), strengthening the rotator cuff and scapular stabilisers, and reducing compensatory movement patterns that can accelerate degeneration. Exercise programs have been shown to improve function and pain in mild to moderate OA. However, outcomes are generally more modest compared to other joints such as the knee or hip, partly due to the complexity of shoulder biomechanics and the difficulty in fully unloading the joint. Corticosteroid injections can provide short-term relief, particularly for painful flare-ups or to facilitate participation in physiotherapy. Evidence suggests benefits may last weeks to a few months, though repeated injections are avoided due to cartilage damage risk. Hyaluronic acid injections have shown limited and inconsistent benefit in the shoulder. When conservative treatment fails, particularly in patients with substantial functional limitations, shoulder arthroplasty (either total or reverse) has been shown to offer excellent pain relief and functional improvement, especially in older adults with end-stage OA. Surgical outcomes depend on patient factors, cuff integrity, and the type of implant used.

Questions about your shoulder pain?