Your Guide to Shoulder Osteoarthritis

To understand how osteoarthritis develops, take a look at how your shoulder joint works.

• Your shoulder joint is where the humeral head (top of your arm bone) fits into the glenoid fossa of your scapula (the portion of bone that includes your shoulder blade). Together, doctors or healthcare professionals call this your glenohumeral joint.
• Cartilage lines the area where these two bones meet. Cartilage is a protective tissue that helps your joints move together smoothly.
• A synovial membrane lines the inner part of your joint. It produces synovial fluid to help your shoulder move more easily.
• Several small, fluid-filled sacs called bursa also help to reduce friction in your shoulder joint when you move your arm.
• Special ligaments help to stabilize your shoulder joint, including your glenohumeral, coracoclavicular, and coracohumeral ligaments.
• Your rotator cuff is a combination of four muscles that form a protective covering around the head of your humerus to enable you to lift and move your arm in a circle.

Osteoarthritis occurs when the cartilage inside the glenohumeral joint starts to wear down. As a result, the bones that make up your joint start to rub together, causing pain.

Aging is the most common cause of shoulder osteoarthritis. Wear and tear on the cartilage occurs over time and affects an estimated one-third of people ages 60 years and older.

Other factors that may influence the development of shoulder osteoarthritis include:

• history of injury or fracture in your shoulder
• family history of osteoarthritis
• having obesity
• inflammation, which can be due to underlying medical conditions or have no known cause
• excessive wear and tear on your joint, such as from performing heavy construction work or playing overhead sports like tennis

A combination of these factors can lead to osteoarthritis in your shoulder. It’s also possible that you have osteoarthritis for no known reason.

Osteoarthritis in your shoulder can cause the following symptoms:

• pain in your shoulder
• stiffness or limited shoulder movement
• weakness in your shoulder

These symptoms usually worsen at night and with any activity that involves lifting your arms over your head.

Sometimes, doctors may find it challenging to diagnose osteoarthritis in your shoulder because of its complexity. Your shoulder joint has many tendons, muscles, bursa, and other components, which can make it difficult for a doctor to identify the source of your pain.

A doctor may use diagnostic methods, including:

• asking questions about your and your family’s medical history
• examining your shoulder’s range of motion
• discussing what triggers your pain and what at-home treatments (if any) relieve it

The doctor may also review other imaging studies, such as an MRI or CT. They will look for a narrow joint space or the formation of extra bone areas called osteophytes that develop due to your bones rubbing together.

If a doctor suspects arthritis, they’ll commonly request an X-ray of your shoulder to look for signs of wear and tear on your joint.

A doctor may also try to rule out other possible causes. For example, if the pain shoots down your arm into your hand or goes up to your neck, it’s possible what feels like shoulder pain actually comes from a neck problem.

A doctor will usually recommend conservative (noninvasive) treatments at first to address your shoulder osteoarthritis. These include:

• medications
• physical therapy
• mobility and strengthening exercises
• injections

If these noninvasive treatments do not work, a doctor may consider a more invasive treatment, such as surgery.

Medications

Doctors may recommend over-the-counter (OTC) or prescription medications to treat your shoulder osteoarthritis. These include:

• OTC nonsteroidal anti-inflammatory drugs (NSAIDs). Examples include:
  • ibuprofen
  • naproxen sodium
• Prescription oral steroids. Examples include:
  • prednisone
  • methylprednisolone

Physical therapy

Doctors may prescribe physical therapy along with conservative measures, such as taking NSAIDs, to improve your range of motion and lower the pain in your shoulder. A physical therapist will likely provide:

• assisted stretching
• an exercise plan designed around your body’s needs
• education on how you can prevent further pain or injury to your shoulder

If your pain is significant, you may not be able to participate in physical therapy until your symptoms improve.

Exercises

It’s a good idea to talk with a physical therapist or doctor before performing at-home shoulder exercises to ensure you’re practicing good form and not putting extra stress on your joints.

Examples of some exercises that can help you when you have shoulder osteoarthritis include:

Pendulum swings

This exercise involves standing with your feet shoulder-width apart while holding onto a sturdy surface on your unaffected side for balance. Lean forward slightly, enough to let your arm dangle while keeping your back straight. Shift your weight side to side, which will cause your arm to move in circles. Repeat 30 times in each direction.

Shoulder elevation stretch

While lying on your back, hold a cane or exercise band in your hands, palms facing upward. In a slow, controlled movement, lift the cane or band toward your head until you feel a gentle stretch in your shoulder. Hold this position for 5–10 seconds, then slowly lower your arms. Repeat 10 times, rest, and perform two additional sets.

Shoulder outward rotation stretch

Like the shoulder elevation stretch, you also perform this exercise lying on your back with a cane or elastic band. Keeping your elbows bent at your sides with your hands grasping the under portion of the cane (palms up), slowly rotate your hand downward to feel a stretch in your shoulder.

Injections

Injections into your shoulder joint are a less invasive approach than surgery — although you may need surgery at a later time). Examples of injections include:

• Platelet-rich plasma (PRP) injections: This involves injecting a special preparation of your blood plasma into your shoulder joint. Ideally, PRP injections help stimulate the healing of damaged tissue in your shoulder.
• Hyaluronic acid injections: Hyaluronic acid is a natural component of the synovial fluids in your body. Injecting lab-made hyaluronic acid may help improve the use and movement of your shoulder.
• Corticosteroids: Corticosteroids are a synthetic form of cortisol, a hormone your body naturally produces. A doctor may inject corticosteroids directly into your shoulder to reduce the inflammation.

A doctor will also consider your overall pain and movement capabilities. If you have severe pain or severely restricted movement, injections may be ineffective.

Surgical treatment

If your shoulder osteoarthritis pain becomes severe and you lose significant use of your shoulder, a doctor may recommend surgical treatment.

Different shoulder surgery approaches exist if you have shoulder osteoarthritis. These include:

• Hemiarthroplasty. Also known as a partial shoulder replacement, this surgery involves either replacing your damaged humerus or arm bone portion while the glenoid portion of your shoulder joint is intact or placing a “cap” over the damaged portion of your humerus (this is known as resurfacing hemiarthroplasty).
• Reverse shoulder arthroplasty. This procedure involves reversing the natural position of your shoulder anatomy to relieve your pain. Typically, the “ball” part of your shoulder’s ball-and-socket joint is on your arm’s side. In a reverse shoulder, the ball is on the socket side of your joint, and the socket is on your arm’s side instead. Surgeons most commonly use this approach if you also have had severe rotator cuff damage.
• Total shoulder arthroplasty. This surgical approach involves replacing both damaged areas of bone in your glenohumeral joint.

The surgical approach depends on your age, symptoms, and the health of the ligaments and tissues surrounding your shoulder joint. A doctor and surgical team will discuss the options with you and inform you which approach best suits your condition.

Here are answers to some frequently asked questions about shoulder osteoarthritis.

What should you not do with shoulder arthritis?

You can aggravate your shoulder osteoarthritis by doing activities that involve lifting heavy objects or raising your arms above your head. That said, you shouldn’t completely stop using your shoulder.

Talk with a doctor about exercises that maintain your strength and range of motion and those that can worsen your shoulder osteoarthritis.

What are the four stages of osteoarthritis in the shoulder?

The osteoarthritis in your shoulder may follow an expected pattern. This includes:

1. Your cartilage starts to soften.
2. Irregularities develop on the surface of your cartilage.
3. The surface of your cartilage starts to flake and wear off.
4. Your cartilage wears off completely, exposing the bone underneath.

This process can happen at different paces. But the more you use your shoulder joint, the faster your cartilage will likely wear away.

How should I sleep with shoulder arthritis?

This answer depends upon the position you prefer to sleep in.

Sleeping on your side. If you’re a side sleeper, you should lie on your unaffected shoulder and place a thick pillow under the arm of your affected shoulder. This pillow helps to elevate your arm and lower pressure.

Sleeping on your back. If you sleep on your back, you should place a pillow under each arm. You could also consider sleeping with a wedge-type pillow that supports your upper body.

Why is osteoarthritis worse at night?

Shoulder osteoarthritis is often worse at night, with many people reporting they can’t fall or stay asleep because of the pain. This is possibly due to the shift in your positioning before you fall asleep, as lying down can put more stress on your shoulder joint, especially if you sleep on your side.

Is osteoarthritis in the shoulder considered a disability?

The Social Security Administration does consider shoulder osteoarthritis a disability in qualifying individuals. You’d have to experience significant functional challenges that keep you from performing your work to qualify.

Ask a doctor if they think you’d be a likely candidate for disability due to the state of your shoulder arthritis.

Can osteoarthritis in the shoulder be reversed?

There’s no cure for osteoarthritis or treatment that can stop or reverse the degenerative process. Instead, treatments aim to reduce discomfort and keep your shoulder moving as it should.