Shoulder Arthritis

What is shoulder arthritis?

Shoulder arthritis is inflammation in your shoulder joint. The inflammation causes pain and stiffness. It makes lifting your arm uncomfortable.

The main joint of your shoulder is a “ball and socket” joint. It’s where the “ball” of your upper arm (humerus) rests against the “socket,” or hollowed-out cup, on the edge of your shoulder blade (scapula). This joint is called the glenohumeral joint.

Shoulder arthritis can also happen at a second joint in your shoulder where your collarbone (clavicle) meets the acromion on your shoulder blade. This joint is called the acromioclavicular joint or AC joint.

Over time, arthritis leads to cartilage loss. Cartilage is the tissue that covers the humeral head and the “socket” of your shoulder joint. Cartilage allows the bone surfaces to glide within the joint. It also cushions your bones against impact.

In the end stage of shoulder arthritis, without protective cartilage, bones in the joint rub directly against each other.

What does shoulder arthritis feel like?

If you have shoulder arthritis, you’ll feel mild-to-severe pain and stiffness in your shoulder. Over time, you’ll notice a loss in your range of motion in your shoulder joint, especially if the glenohumeral joint is involved.

You may feel pain when you reach overhead, lift heavy objects or play sports or join in activities that involve a range of arm movements. In late-stage disease, you may not be able to complete simple everyday tasks without pain. These tasks include such things as bathing, grooming and even writing or using your computer.

Where in the shoulder is pain felt and what might it mean?

The location of your shoulder pain may help tell which shoulder joint is affected.

• If your pain at the side of your shoulder and your ache feels like it’s deep in the joint, it likely involves your glenohumeral joint.
• If you feel pain at the top of your shoulder that sometimes travels to the side of your neck, it likely involves your acromioclavicular (AC) joint.

Who gets shoulder arthritis?

Shoulder arthritis:

• Is more common in people over age 50.
• Happens in younger people with rheumatoid arthritis or after shoulder trauma, such as from broken shoulder bones, shoulder dislocation or infection.

What are the signs and symptoms of shoulder arthritis?

Symptoms of shoulder arthritis vary from person to person. Signs and symptoms include:

• Pain in your shoulder joint: This is the most common symptom. At first, you may feel shoulder pain only during activity. Later in the disease process, you may feel pain at any time of the day, with or without arm movement. Your pain may worsen when you lift heavy objects or after exercise. The pain may spread down your arm and even to your elbow or wrist if your arthritis is severe.
• Stiffness and loss of range of motion: You may feel stiffness in your shoulder and lose range of motion. These symptoms may make everyday tasks — such as dressing, bathing, driving or doing housework — difficult.
• Grinding, clicking, popping or cracking in your shoulder joint: Loss of cartilage, which leaves an unsmooth surface, causes these noises. The noises occur with or without pain.
• Loss of sleep: It’s difficult to find a comfortable sleeping position. Any shoulder movement may cause pain. If you sleep on your back, place a pillow under the elbow of your affected side. This helps keep your shoulder in a more supported position. It also takes the strain off of all supporting joint structures. For some people, sleeping in a recliner can provide pain relief at night.

What causes shoulder arthritis?

Shoulder arthritis has many possible causes. They include:

• Osteoarthritis: This is the most common type of arthritis. This is the “wear and tear,” age-related type of joint disease. Cartilage gets soft, cracks, flakes or becomes frayed and eventually wears away. This exposes the bones beneath the cartilage, which begin to rub or grind against each other. Like the tires on your car, joint surfaces don’t wear down evenly or at the same rate.
• Rheumatoid arthritis:This is an autoimmune disease, which means your body’s defense system attacks its own healthy tissues. In rheumatoid arthritis of your shoulder, your immune system attacks the joint and joint lining, causing the lining to swell. The disease process eventually damages the cartilage.
• Rotator cuff tear arthropathy: The rotator cuff is a group of four tendons that surround your shoulder joint and keep your shoulder stable as the “ball” of your upper arm rotates in your shoulder blade socket during movement. Tearing of these tendons (rotator cuff tears) usually happens as slow fraying and wearing over time. . In some instances, these tears can slowly become very larger over time, to the point of that the humeral head slides out of its normal position and rubs against other shoulder bones, leading to cartilage wear and arthritis
• Trauma to your shoulder: Any type of injury to the bones of the shoulder — including dislocation, fracture or severe impact — can damage the cartilage surface.
• Avascular necrosis: This condition, also called osteonecrosis, is the death of part of the “ball” of your shoulder. Trauma or disease cut off blood flow to the bone. Without bone support, the cartilage becomes damaged and eventually, the shoulder joint breaks down.

How is shoulder arthritis diagnosed?

Your healthcare provider will perform a physical exam of your shoulder, including checking the range of motion and strength. Your provider will also ask about your medical history and current symptoms.

Your provider will order imaging tests, including:

• X-rays: X-rays show the condition of your shoulder bones. They can’t directly show cartilage, but your provider can see the amount of space between your shoulder bones. Being very close or touching means you’ve lost cartilage.
• Computed tomography (CT) scan: This test provides more detail of the bones of your shoulder joint than X-rays and is frequently ordered for surgical planning
• Magnetic resonance imaging (MRI): This test shows the surrounding soft tissues of your shoulder joint. Your provider may order it to look at the condition of the rotator cuff tendons.

How is shoulder arthritis treated?

Treatment options include home-based and lifestyle care, medications, and finally, surgery.

Home-based and lifestyle care

Shoulder arthritis treatments usually begin with nonoperative, home-based and lifestyle care. These methods keep your shoulder mobile and reduce pain. These treatments include:

• Shoulder exercises: Stretching exercises help improve or retain your range of motion. Your provider may have you work with a physical therapist.
• Activity and lifestyle adjustments: Let pain be your guide. Cut back or avoid everyday activities (for example, lifting heavy objects) or athletic activities that cause shoulder pain.
• Ice and heat: Apply ice or moist heat — whichever feels better — to reduce inflammation and ease your pain. If cold is your choice, place a reusable frozen cold pad or even a frozen bag of peas on your shoulder. Apply the cold pack for 20 minutes at a time, several times a day as needed. Moist heat is a nice option for warming up before stretching or any other time that helps make you feel more comfortable.

Medications

Medications relieve pain and reduce inflammation. Common options are:

• Over-the-counter medications: For short-term pain relief, common choices are acetaminophen (Tylenol®) or a nonsteroidal anti-inflammatory drug (NSAIDS), such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®). Take only the dosage recommended on the product label or by your provider. High dosages or long-term use can irritate your stomach or cause liver or kidney problems. Never hesitate to contact your provider if you are having side effects. If you need a stronger or longer-lasting medication, talk with your provider. They may order a prescription NSAID.
• Injections: The most common option is an injection of a corticosteroid. Your provider injects the medication into the joint space in your shoulder. Cortisone relieves pain by reducing inflammation in the joint. Because its effects last a few months, you may need several injections during the year.

Shoulder surgery

If other treatment methods don’t relieve your pain and your arthritis is getting worse, surgery may be an option. Common surgical options include:

• Total shoulder replacement surgery: In this surgery, plastic and metal replace the diseased sections of bones in your shoulder joint. Your surgeon removes part of the “ball” of your humerus head. It’s replaced with a new metal head that attaches to a metal stem that goes inside your humerus bone. A smooth plastic socket covers your shoulder socket.
• Reverse total shoulder replacement surgery: In this surgery, your surgeon reverses the location of the ball and socket. A metal head attaches to your shoulder blade and a socket attaches to your humerus.
• Arthroscopic shoulder debridement: In this surgery, small tools and a camera are inserted through small incisions in your shoulder. Your surgeon removes loose fragments of damaged cartilage in your shoulder joint. They also file down bone spurs (if present). This may be an option if you have early arthritis with some cartilage left. Although this procedure doesn’t stop arthritis, pain relief may last up to 24 months.
• Resection arthroplasty: This is the most common surgery for arthritis in the acromioclavicular (AC) joint. In this surgery, your surgeon removes a small amount of bone from the end of your collarbone. The space between your collarbone and shoulder blade fills in with scar tissue.

Your surgeon may consider variations of these main types of surgeries based on the type, location and severity of your arthritis.

Are glucosamine or chondroitin useful supplements for shoulder arthritis?

Some people who have arthritis say that glucosamine and chondroitin help relieve their joint pain. These personal reports are hard to evaluate. The Food and Drug Administration doesn’t regulate supplements. Unlike medications, there’s not a lot of scientific evidence to confirm that supplements help treat arthritis.

Always ask your healthcare if you are thinking about taking these or any other supplements, herbal products or other over-the-counter medications. They’ll share their knowledge as well as make sure these products aren’t interfering with your current medications.

Can shoulder arthritis be prevented?

You can lower your chances of developing arthritis, in general, by:

• Avoiding tobacco products. If you use tobacco products, your provider can give you tips to quit and offer information on support services.
• Doing low-impact, non-weight-bearing exercise.
• Maintaining a healthy body weight.
• Eating a healthy diet, such as the Mediterranean diet.
• Reducing your risk of joint injuries. Avoid or limit activities that put your shoulder at risk of injury.

See your healthcare provider at the first sign of symptoms. If your shoulder problem is found early, you can learn ways to reduce pain, change or avoid certain activities and reduce further cartilage damage.

Can arthritis be cured?

There’s no cure for arthritis. However, many nonsurgical and surgical treatments can treat your symptoms so that you can continue to have an active life.

What outcome can I expect if I have shoulder arthritis?

Your outcome depends on your age, your activity level and the types and range of movements you make with your arm and shoulder. Also, the location, size and the severity of your shoulder arthritis.

Because each person and shoulder situation is unique, ask your provider what outcome you can expect as you explore all treatment options.

What is a frozen shoulder?

Frozen shoulder, also called adhesive capsulitis, is a painful shoulder condition. Like shoulder arthritis, both conditions involve pain and loss of motion in your shoulder.

Frozen shoulder occurs when the strong connective tissue surrounding the shoulder joint (called the shoulder joint capsule) becomes thick, stiff, and inflamed. Even without treatment, frozen shoulder gets better on its own. This may take from a few months to a couple of years.

Shoulder arthritis doesn’t get better on its own. Arthritis attacks the shoulder joint itself, not the surrounding joint capsule.