Shoulder Osteoarthritis: An Underestimated Condition
Omarthrosis (shoulder joint osteoarthritis) affects millions of people in Germany – and is often diagnosed later than knee or hip osteoarthritis. Typical symptoms include pain during movement, restricted rotation, and a grinding sensation in the joint. Viscosupplementation with hyaluronic acid is an effective, minimally invasive treatment option – also for the shoulder joint.
Anatomy of the Shoulder Joint: Special Features
The shoulder joint (glenohumeral joint) is the most mobile joint in the human body – and thus particularly susceptible to wear and tear. In contrast to the knee and hip, the shoulder joint is a ball-and-socket joint with limited bony guidance – stability is primarily provided by the rotator cuff.
- Joint Head: Humeral head (large, round)
- Joint Socket: Glenoid (small, shallow) – only covers 25–30% of the humeral head
- Rotator Cuff: 4 muscles stabilize the joint
- Joint Volume: Approx. 10–15 ml (smaller than the knee)
Injection Technique: Shoulder Joint
Injection into the shoulder joint requires experience and should ideally be performed under ultrasound guidance. There are two standard approaches:
Anterior Approach (front)
- Patient sits upright, arm hanging loosely
- Puncture medial to the coracoid, lateral to the cephalic vein
- Needle towards the glenoid
- Advantage: Easily palpable landmarks
Posterior Approach (back)
- Patient sits, arm crossed in front of the body
- Puncture 2 cm inferior and medial to the posterior border of the acromion
- Needle towards the coracoid
- Advantage: Fewer vessels in the injection path
Suitable Preparations for the Shoulder Joint
Medium-viscosity hyaluronic acid preparations that can spread evenly in the joint are suitable for the shoulder joint. The joint volume is smaller than in the knee – therefore, preparations with 1–2 ml volume are preferred.
Ostenil Plus 40mg/2ml – Highly concentrated HA with mannitol antioxidant. Approved for multiple joints including the shoulder. 3–5 weekly injections, duration of action up to 9 months.
Ostenil 20mg/2ml – Classic preparation for the 3–5 injection series. Proven and well-tolerated also in the shoulder joint.
Ostenil Mini 10mg/1ml – The reduced volume of 1 ml is ideal for the shoulder joint and the acromioclavicular joint (AC joint).
Hyalubrix 30mg/2ml – High molecular weight HA for optimal viscoelastic properties. Well suited for the shoulder joint.
Durolane 60mg/3ml – Single-shot option also for the shoulder joint. One injection, up to 6 months duration of action.
Indications: When is shoulder injection useful?
- Omarthrosis Grade I–III according to Kellgren-Lawrence
- Rotator cuff tendinopathy (peritendinous with Ostenil Tendon)
- Shoulder impingement syndrome
- Frozen Shoulder (adhesive capsulitis) – as an adjunct to physiotherapy
- Acromioclavicular joint osteoarthritis (AC joint)
- Patients who wish to postpone shoulder replacement surgery
Comparison: Shoulder vs. Knee – What's different?
| Feature | Shoulder Joint | Knee Joint |
|---|---|---|
| Joint Type | Ball-and-socket joint | Hinge joint |
| Joint Volume | 10–15 ml | 30–50 ml |
| Imaging Needed | Recommended (ultrasound) | Optional |
| Preferred Volume | 1–2 ml | 2–6 ml |
| Accuracy without Imaging | 60–70 % | 80–90 % |
When is injection less suitable?
- Advanced omarthrosis (Grade IV) with massive deformity
- Active joint infection
- Known HA allergy
- Complete rotator cuff tear (relative contraindication)
Conclusion for Practice
Hyaluronic acid injection into the shoulder joint is an effective, well-tolerated treatment option for omarthrosis and shoulder impingement. Ultrasound-guided injection and the correct product selection are crucial for treatment success.
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