Aetiology
- Less common than hip or knee osteoarthritis
- Primary osteoarthritis mostly over 60 years
- Instability arthropathy after dislocation or stabilisation, especially nonanatomic procedures
- Trauma, avascular necrosis, inflammatory arthritis, cuff arthropathy and chondrolysis
Clinical Features
- Deep shoulder pain, night pain and progressive stiffness
- Loss of active and passive range, with external rotation lost early
- Posterior joint line crepitus
- Rotator cuff integrity must be assessed
Investigations
- True AP, axillary and scapular Y views
- Joint space loss, inferior humeral osteophyte (goat’s beard), sclerosis and posterior glenoid wear
- CT with 3D reconstruction defines version, inclination, bone loss and subluxation
- MRI or ultrasound when cuff integrity is in doubt
Classification
Walch (axial CT)
| Type | Description |
|---|---|
| A1 | Central minor erosion, centred head |
| A2 | Central major erosion, centred head |
| B1 | Posterior narrowing and subluxation without bony erosion |
| B2 | Biconcave glenoid with posterior erosion |
| B3 | Monoconcave posterior erosion with retroversion and posterior subluxation |
| C | Excessive dysplastic retroversion |
| D | Glenoid anteversion or anterior subluxation |
Original publication Walch G, Badet R, Boulahia A, Khoury A. Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty. 1999;14(6):756-60.
Management
- Analgesia, activity modification, physiotherapy and intra-articular corticosteroid
- Arthroscopic debridement, capsular release or CAM procedure for younger concentric disease
- Anatomic TSR is standard with an intact cuff and adequate glenoid bone
- Anatomic TSR gives better pain relief and function than hemiarthroplasty
- Glenoid loosening is the main long term failure mode
- Reverse TSR for cuff deficiency, cuff tear arthropathy and fracture sequelae
- Reverse TSR for older patients with B2, B3 or C glenoids or posterior subluxation
- Hemiarthroplasty, with or without ream and run, in young active patients to avoid glenoid wear
- Eccentric reaming, augmented components or bone graft correct glenoid deformity
- Common and often asymptomatic on imaging
- Superior pain, local tenderness and pain on cross body adduction
- Diagnostic and therapeutic injection
- Distal clavicle excision, open (Mumford) or arthroscopic
- Preserve superior and posterior AC ligaments to avoid instability
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.