Your Guide to Shoulder Osteoarthritis

Causes of osteoarthritis in your shoulder

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

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• Your shoulder joint is formed when 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.
• The area where these two bones meet is lined with cartilage. Cartilage is a protective tissue that helps your joints move together smoothly.
• A synovial membrane lines the inner part of your joint, which produces a fluid called 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 your glenohumeral joint starts to wear down. As a result, the bones that make up your joint start to rub together, which is painful.

Aging is the most common cause of shoulder osteoarthritis. Wear and tear on your 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
• 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 your can have osteoarthritis for no known reason.

Symptoms of osteoarthritis in the shoulder

Osteoarthritis in your shoulder can cause the following symptoms:

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

These symptoms are usually worse at night and with any activity that requires you to lift your arms over your head.

Getting a diagnosis for osteoarthritis in the shoulder

Diagnosing osteoarthritis in your shoulder can be tricky, often due to your shoulder joint’s complexity. As you read in your shoulder joint anatomy description, there are lots of tendons, muscles, bursae, and more that are a part of your shoulder joint. Doctors have to narrow down the source of your pain, and that can be challenging.

Some of the diagnostic methods include:

• Asking you questions about your medical history, as well as your family’s.
• Examining your shoulder to see your range of motion.
• Discussing what triggers your pain and what at-home treatments (if any) relieve it.
• 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.
• Reviewing other imaging studies, such as an MRI or CT, which will usually show a narrow joint space or formation of extra bone areas called osteophytes from your bones rubbing together.

A doctor may also try to rule out other possible causes. For example, if your 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.

Treatment options for osteoarthritis in the shoulder

A healthcare professional will usually recommend conservative (noninvasive) treatments at first to address your shoulder osteoarthritis.

Medications for osteoarthritis in the shoulder

Doctors may recommend over-the-counter medications to treat your shoulder osteoarthritis. These include nonsteroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDs include ibuprofen and naproxen sodium.

A doctor may also prescribe oral steroids, such as prednisone or methylprednisolone, to treat inflammation. But this is sometimes controversial, as research on oral and injection-based steroids has been mixed. If you have concerns about steroid use in your treatment plan, be sure to discuss that with a doctor.

Physical therapy for osteoarthritis in the shoulder

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

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

Exercises for osteoarthritis in the shoulder you can do at home

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. But 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 for balance on your unaffected side. Lean forward slightly, enough to let your arm dangle, while keeping your back straight. Shift your weight side to side, which will have your arm 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 to 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, this exercise is also performed 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 for osteoarthritis in the shoulder

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

• Platelet-rich plasma injections. This injection approach involves using a special preparation of your blood plasma and injecting it into your shoulder joint. Ideally, platelet-rich plasma 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 to improve your use of and movement in 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 lower the inflammation.

A doctor will also consider your overall pain and movement capabilities. If you have severe pain or severely restricted movement, injections may not be enough.

Surgical treatment for osteoarthritis in the shoulder

If your shoulder osteoarthritis pain progresses to be 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. A reverse shoulder arthroplasty involves reversing the natural position of your shoulder anatomy to relieve your pain. Normally, 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. The approach is most commonly used 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 upon your age, symptoms, and the health of your ligaments and tissues surrounding your shoulder joint. A doctor and surgical team will be able to discuss the options with you and inform you as to which approach is best suited to your condition.

Frequently asked questions

The following are some frequently asked questions regarding shoulder osteoarthritis.

What are the four stages of osteoarthritis in the shoulder?

Like in some people, the osteoarthritis in your shoulder may follow an expected pattern. This includes:

• Your cartilage starts to soften.
• Irregularities start to develop in the surface of your cartilage.
• The surface of your cartilage starts to flake and wear off.
• 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 is likely to 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 sleep on your side, 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 known to often be 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 are aimed at reducing discomfort and keeping your shoulder moving as it should.

Takeaway

The shoulder joint is the third most common joint in your body that osteoarthritis affects, and there’s a wide network of support groups for those living with this disorder.

Treatments range from noninvasive injections to surgery and are aimed at lowering pain and improving your range of motion. If you have shoulder pain that’s impacting your quality of life, talk with a doctor to determine if shoulder osteoarthritis could be the cause.