Glenohumeral osteoarthritis (GHOA) is a degenerative condition with significant impact on shoulder function, range of motion, and quality of life. While primarily affecting individuals over 60 years old, GHOA in younger patients is also described as mostly secondary to trauma, instability, or inflammatory conditions, presenting unique management challenges due to their higher activity levels and prosthetic longevity concerns. Management strategies range from conservative approaches, such as physical therapy, anti-inflammatory medications, and intra-articular injections, to surgical intervention. Total shoulder arthroplasty is a well-established option for older patients but poses limitations for younger, active individuals. Joint-preserving surgical techniques, including cartilage repair and biologic resurfacing, offer potential benefits, though their outcomes remain variable. Arthroscopy plays an important role in managing GHOA, especially in younger patients, aiming to delay or avoid arthroplasty. This minimally invasive technique enables diagnostic evaluation of the joint and targeted therapeutic interventions, such as capsular release, osteophyte resection, and cartilage debridement. Arthroscopy allows symptom relief, preserves joint mobility, and addresses associated pathologies, making it a valuable option in cases where conservative measures fail and joint replacement is undesirable. This chapter explores the pathophysiology, diagnosis, and treatment of GHOA, emphasizing arthroscopic interventions as a joint-preserving alternative to arthroplasty in younger, active patients.