Shoulder Joint Cartilage Injuries: Treatment Options

Shoulder Joint Cartilage Injuries: Treatment Options

Without treatment, cartilage defect injuries of the shoulder are at risk of getting worse. Nonoperative treatment involves activity modification, including the use of rest and ice, NSAID medication, physical therapy, and therapeutic injections into the shoulder. While these treatments can help manage symptoms, they do not fix the underlying cause. If nonoperative treatment does not provide lasting symptom relief, surgery may be considered for certain cases, including cartilage defects at one specific area and pain that is difficult to control.

If there is widespread cartilage damage from osteoarthritis, a shoulder replacement is a more appropriate surgical option to replace the shoulder joint surfaces because too much cartilage is damaged. In cases of isolated cartilage defects, however, there are a variety of different procedures that can be performed to preserve or restore the cartilage. These procedures are recommended for younger and more active patients who do not improve with conservative treatment. Surgical options include: chondroplasty, where the damaged cartilage is smoothed out; marrow stimulation, where small holes are drilled into the underlying bone to stimulate healing; osteochondral autologous transplantation, referred to as an OATS procedure, where a piece of cartilage and bone, called a plug, is transferred from a healthy non-weight-bearing area of the patient’s knee into the cartilage defect; and cartilage transplantation, where cartilage is taken from a cadaver donor and transferred into the cartilage defect.

During surgery, a patient’s arm will be positioned in an arm holder in either the beach chair position or on their side in the lateral decubitus position. Surgery is typically performed arthroscopically through tiny incisions around the shoulder. If other conditions, like a labral tear or rotator cuff tear, are present and have led to the cartilage defect, additional surgery may be needed to address these issues. The decision to undergo surgery should be made after a discussion between the patient and health care provider about the potential risks and benefits of the operation.

Studies suggest that there is not one type of surgery that is best, and all procedures are associated with good outcomes, including improved pain relief, shoulder function, and low rates of complications. Depending on the size of the cartilage defect, there is a risk that further surgery may be needed. Some large cartilage injuries may ultimately require a shoulder replacement to replace the joint surfaces of the shoulder to fully address the cartilage damage. Rehabilitation after surgery will depend on the procedure performed and the surgeon’s preference. Typically, there is an initial period of wearing a shoulder sling and avoiding lifting and active arm movement for several weeks, followed by a gradual increase in range of motion and strength.