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Shoulder Arthritis

The ball-and-socket joint of the shoulder is frequently affected by arthritis. Many people are managed without surgery, particularly in the earlier stages.

The glenohumeral joint is the ball-and-socket joint between the head of the upper arm bone and the shoulder blade, and it is frequently affected by arthritis. Arthritis means that the smooth cartilage lining the joint surfaces has been damaged or worn away, so that the surfaces no longer glide easily against one another.

Osteoarthritis is the most common form of shoulder arthritis. In some patients, rheumatoid arthritis or another inflammatory arthritis is responsible for the symptoms instead, and these conditions behave somewhat differently because the problem begins in the lining of the joint rather than in the cartilage surface.

Arthritis of the shoulder tends to progress slowly over years. Treatment is matched to how severe the symptoms are and how much they interfere with daily life, and a good proportion of people are managed without an operation, particularly in the earlier stages.

Symptoms

  • Pain is the main symptom. It may be felt at the front or the back of the shoulder, depending on which joint is affected.
  • Stiffness, with loss of movement, particularly rotation.
  • A grating or grinding sensation during movement.
  • Inflammation, which may be caused by loose bodies within the joint, meaning fragments of cartilage that have broken away from the joint surface.
  • Symptoms tend to worsen as the condition progresses.

Causes

  • Osteoarthritis. The cartilage surfaces rub together in a way that causes the cartilage to deteriorate. This may follow a previous shoulder injury, it may follow overuse, or it may occur with age alone.
  • Previous injury. A bone or a tendon that heals in an incorrect position can change the way the joint moves. Even a slight difference in position can cause the cartilage surfaces to rub, and they then gradually wear down.
  • Rheumatoid arthritis. An inflammatory condition that affects the lining of the joints and, over time, can destroy the cartilage.
Image of an arthritic shoulder joint showing loss of the cartilage surface between the head of the upper arm bone and the socket

Treatment

Treatment depends on the severity of the arthritis and on how far it has progressed. Non-surgical measures are used first. If they do not control the symptoms, surgical options may be discussed.

Non-surgical treatment

Non-surgical management combines activity modification, rest, physiotherapy and simple analgesics.

  • Activity modification. Avoiding the activities that aggravate the shoulder is the cornerstone of treatment.
  • Physiotherapy. Aims to strengthen the muscles around the shoulder and improve shoulder function.
  • Simple analgesics. Regular paracetamol is often effective for pain, and slow-release preparations are helpful for many people.
  • Anti-inflammatory medication. Used intermittently rather than continuously.
  • Cortisone injections. An injection into the joint may reduce inflammation and pain, but the effect is usually temporary and rarely lasts more than a few months.
  • Platelet rich plasma (PRP) injections. These have been helpful for some people.
  • Hyaluronan injections. Hyaluronan preparations such as Synvisc have not been found to be as effective in the shoulder as they are in the knee.

Surgical treatment

Surgery may be discussed if non-surgical treatment has not controlled the symptoms. The option chosen depends on the severity of the arthritis and on the condition of the rotator cuff.

  • Total shoulder replacement. The usual surgical treatment for severe arthritis of the glenohumeral joint. The whole joint is replaced with a prosthesis, with a component replacing the head of the upper arm bone and a component resurfacing the socket.
  • Hemiarthroplasty, or half joint replacement. In some cases this may be suitable instead of a total replacement. Only the head of the upper arm bone is replaced.
  • Reverse total shoulder replacement. Considered where severe arthritis is accompanied by an irreparable rotator cuff tear, or after certain fractures. The positions of the ball and socket are reversed so that the deltoid muscle can power the shoulder.

Recovery after a shoulder replacement usually takes 3 to 6 months. Patients frequently need to wear a sling for 6 weeks after surgery, and physiotherapy guides recovery during that time. All of the risks of surgery, including the risks of general anaesthetic, infection, nerve injury, stiffness and the possibility that a prosthesis loosens or wears over time, are discussed during consultation before any operation.

What to do next

If your shoulder is painful, stiff and grinding, an assessment will establish whether arthritis is responsible and how advanced it is. Background on the joint is on the shoulder anatomy page, arthritis of the AC joint is covered separately on the AC joint arthrosis page, and the operations above are described under shoulder surgery. Recovery is covered under rehabilitation.

To arrange an assessment, see consultation. The consultation FAQs explain what to bring, the surgery FAQs answer common questions about having an operation, and accommodation has information for patients travelling to Brisbane.

This page is general information and is not a diagnosis. Individual circumstances vary, and the right treatment for you can only be determined after assessment. Any procedure carries risk; these are discussed in consultation.