Shoulder Arthritis Info
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Video transcript
Shoulder arthritis develops when the smooth cartilage lining the ball-and-socket joint gradually wears away. As the bones begin to rub together, you feel a deep ache, stiffness, and sometimes a grinding or catching. Reaching overhead, out to the side, or behind your back becomes harder and more painful. The ache is often worst with use, and can disturb your sleep at night. It usually comes on slowly over years, and is more common with age, or after an old injury. Many shoulders are managed for a long time without surgery, especially in the earlier stages. Gentle exercises, guided by a physiotherapist, help keep movement and strength around the joint. Anti-inflammatory medication can settle the painful flares, and a cortisone injection into the joint can give useful relief. Easing heavy overhead activities takes some of the strain off the worn joint. When the pain becomes constant and limits daily life despite these measures, a joint replacement can help. A shoulder replacement resurfaces the worn joint with smooth implants, much like a hip or knee replacement. When the rotator cuff tendons are intact, an anatomic replacement restores the natural ball-and-socket. When the cuff is worn or torn, a reverse replacement is used, which swaps the ball and socket around so the remaining muscles can power the arm. It is done under anaesthetic through an incision at the front of the shoulder, usually with a short hospital stay. The aim is to relieve the pain, and restore comfortable, useful movement. The arm rests in a sling for around six weeks, to protect the new joint while it settles. Physiotherapy starts gently within the first few weeks, and moves through stages, protected movement first, then active movement, and strengthening later on. Pain relief is usually noticed early, with movement and strength building over the following months. It asks for patience, as a shoulder replacement keeps improving for a year or more. Keeping up the program gives the best long-term result.
Shoulder arthritis causes pain, stiffness, and reduced range of motion — diagnosis and treatment options explored.
What you're feeling
Shoulder arthritis often starts as a dull, deep ache that you might mistake for a minor strain. Over time, the pain becomes more constant and is frequently worse at night, making it difficult to sleep on that side. You may notice a grinding or clicking sensation when you move your arm, along with a steady loss of flexibility.
Common activities that trigger this pain include reaching overhead to grab a plate from a cupboard or reaching behind your back to fasten a bra. Simple tasks like tucking in a shirt or brushing your hair can become frustratingly difficult. The stiffness is often most noticeable in the morning or after periods of inactivity, though it can also flare up after heavy use.
What's actually happening
Your shoulder is a ball-and-socket joint where the round head of your upper arm bone fits into a shallow cup on your shoulder blade. In a healthy shoulder, smooth cartilage covers these bones, allowing them to glide effortlessly. In shoulder arthritis, this protective cartilage wears away. As the cartilage thins, the bones begin to rub against each other, causing pain and inflammation.
This wear and tear can happen for several reasons. Sometimes it is primary, meaning it develops gradually with age and general use. In these cases, factors like genetics, previous injuries, or repetitive overhead movements can speed up the process. In other cases, it is secondary, meaning it follows a specific event. For example, a large, untreated rotator cuff tear can change how the shoulder moves, causing the ball of the arm bone to migrate upward and grind against the socket. This specific type is called cuff tear arthropathy.
Recurrent shoulder dislocations can also lead to arthritis. Each time the shoulder pops out of place, it can damage the cartilage lining the joint. Over years, this damage accumulates, leading to the rough, painful surfaces characteristic of arthritis. Additionally, the shape of your shoulder blade can influence how the joint wears down. Some people naturally have a socket that tilts backward, which concentrates stress on the back part of the joint, leading to a specific pattern of bone loss and wear.
What we can do about it
Treatment usually begins with non-surgical options aimed at managing pain and maintaining function. Physical therapy is a cornerstone of care. A therapist will guide you through gentle exercises to keep the joint mobile and strengthen the surrounding muscles, which helps support the shoulder. It is important to respect your pain limits during these exercises; pushing too hard can increase inflammation.
Injections can also provide significant relief. Corticosteroid injections reduce inflammation and can ease pain for several months. However, your surgeon will likely limit the number of these injections to avoid potential side effects. Other injectable options, such as hyaluronic acid or platelet-rich plasma, are sometimes used, though evidence for their long-term benefit in the shoulder is still evolving.
If non-surgical treatments no longer provide relief, surgery may be considered. For younger, active patients with early-stage arthritis, arthroscopic debridement might be an option. This minimally invasive procedure involves cleaning out loose debris and smoothing rough surfaces to relieve pain. While it can provide temporary relief, it does not stop the progression of arthritis.
For end-stage arthritis, shoulder replacement is the standard solution. There are two main types. Anatomic total shoulder replacement mimics the natural joint structure and is typically used when the rotator cuff muscles are intact. Reverse total shoulder replacement flips the ball-and-socket design. This is often chosen for patients with significant bone loss, cuff tear arthropathy, or those who have failed previous surgeries. Reverse replacements rely on the deltoid muscle rather than the rotator cuff to lift the arm. Recovery from any shoulder surgery requires dedicated rehabilitation, but most patients experience substantial pain relief and improved function.
When to see someone
You should consult a clinician if shoulder pain persists for more than a few weeks despite rest and over-the-counter pain relievers. Seek prompt evaluation if you experience sudden, severe pain after an injury, or if you notice significant swelling, redness, or warmth around the joint. Other reasons to seek care include an inability to lift your arm, a feeling of the shoulder "locking" or catching, or pain that consistently disrupts your sleep. Early assessment can help determine the best path to manage your symptoms and preserve shoulder function.
