The Shoulder is a Weight Bearing Joint: Implications for Clinical Practice

Abstract

This paper draws together clinically important information from a diversity of sources. Issues addressed relate to the concept of the glenohumeral joint as a weight bearing structure and the diagnosis and treatment of adhesive capsulitis. The glenohumeral joint is conventionally regarded as non weight-bearing. The use of simple physical principles predicts that this is not the case and recent research suggests that forces equivalent to three times body weight are experienced by the shoulder during simple activities of daily living. There is a belief that intraarticular corticosteroid is potentially harmful to weight-bearing joints. Analysing the literature shows that this risk is overstated and only applicable in certain specific clinical situations. Steroid injection is a frequently used therapy for adhesive capsulitis of the shoulder. Studies addressing its efficacy have been devalued by poor methodological quality but there is good enough evidence to support the continued use of intraarticular steroid provided strict diagnostic criteria are applied. There is an urgent need for a formal metanalysis of the available literature and for further randomised, controlled clinical trials.