Shoulder Arthritis

What is shoulder arthritis?

Shoulder arthritis is inflammation of the shoulder joint, where the upper arm bone (humerus) meets the shoulder blade (scapula) and collarbone (clavicle). This inflammation can be caused by osteoarthritis or "wear-and-tear," injury to the shoulder joints, rotator cuff injuries, or rheumatoid arthritis.

Symptoms include shoulder pain that may get worse with movement or while sleeping, shoulder stiffness or limited mobility, as well as warmth, redness, or swelling of the shoulder area.

Treatment depends on the severity of your discomfort but may include rest, methods to alleviate pain, exercises to strengthen and stabilize the shoulder, steroid injections, and surgery.

Recommended care

You should visit your primary care physician who will likely coordinate care with an muscle and bone specialist (orthopedic surgeon). Treatment for arthritis may involve pain killers to ease the pain, physical therapy, corticosteroid injections into the shoulder, and surgery in rare, more severe, cases.

Shoulder arthritis symptoms

Symptoms of shoulder arthritis mainly include the following.

• Shoulder pain: This pain usually starts gradually and gets worse with movement, although over time the pain can occur at night and interfere with sleep. The pain is usually located at the front of the shoulder but may be located in the back of the shoulder or throughout the shoulder, depending on the type of arthritis. It may be painful to push along the joint line.
• Shoulder stiffness or limited range of motion: Some with shoulder arthritis may develop stiffness of the shoulder or a limitation in their range of motion. It may be hard to lift the arm up, such as when combing the hair or reaching for objects. A grinding or cracking sound may be heard as the arm is moved.
• Shoulder warmth, redness, or swelling: Some people with shoulder arthritis may develop warmth, redness, or swelling of the shoulder joint. Warmth, redness, and substantial swelling is more common in rheumatoid arthritis (an inflammatory condition) than in osteoarthritis, which is more due to the physical wear-and-tear of the joint.

What causes shoulder arthritis?

The end of the humerus, or upper arm bone, is shaped like a ball, which normally fits within a socket on the scapula, called the glenoid. The shoulder joint is stabilized by a set of muscles and tendons called the rotator cuff. Symptoms of shoulder arthritis can be felt throughout or stem from issues in these areas. Specific causes include osteoarthritis, injuries, and rheumatoid arthritis.

Osteoarthritis

The most common form of arthritis that affects the shoulder is osteoarthritis, which results from normal "wear-and-tear" of the shoulder joint. The bones of the shoulder are normally covered with cartilage, a substance that acts as a cushion and allows the bones to glide smoothly past each other. Over time, the cartilage covering the ends of the bones degenerates, allowing the bones to rub against each other and cause joint damage. Shoulder osteoarthritis usually affects people who are older than 60 years of age.

Injury to the shoulder joints

These injuries can increase the risk of developing osteoarthritis because joints that have been damaged tend to generate more friction and are more prone to sustaining further damage. The injury may have occurred years before the shoulder arthritis develops.

Rotator cuff muscle injuries ("cuff tear arthropathy")

Injuries to the rotator cuff muscles, such as a large tear, can also increase the risk of developing osteoarthritis of the shoulder joint. The rotator cuff muscles normally help keep the shoulder joint in place, so an injury to the rotator cuff muscles can cause the bones of the shoulder joint to become misaligned and damage each other as they rub against each other.

Rheumatoid arthritis

Another form of arthritis is known as rheumatoid arthritis (RA), which is an autoimmune disorder that can cause inflammation in multiple joints throughout the body. Rheumatoid arthritis involves inflammation of a fluid within the joints that normally lubricates and cushions the joint. Inflammation of this fluid eventually damages the surrounding cartilage and bone. Rheumatoid arthritis typically affects the small joints of the hands and wrists, but can sometimes affect large joints such as the shoulder.

Treatment options and prevention for shoulder arthritis

Shoulder arthritis is a chronic condition that usually cannot be completely cured. Therefore, treatments focus on controlling symptoms and slowing the progression of the disease. Specific treatment options include pain medication, heat or cold, rest, certain stretches and exercises, steroid injections and surgery.

Pain medications

Mild pain can usually be managed with over-the-counter painkillers such as acetaminophen (Tylenol), or NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve). More severe pain may be managed with prescription pain medications such as celecoxib (Celebrex) or tramadol (Ultram).

Heat or cold

Some people with shoulder arthritis may experience a reduction in their pain by applying heat or cold to the shoulder for 10 to 15 minutes at a time, multiple times per day. This can help reduce inflammation and alleviate pain.

Rest and activity restriction

Those who develop a flare-up of shoulder arthritis may benefit from a period of rest and restricting their activities, such as heavy lifting, reaching overhead, or forceful pushing or pulling. This will give the joint time to rest and heal.

Stretching and shoulder strengthening exercises

After the acute episode of pain is controlled, your physician may recommend that you perform stretching and shoulder strengthening exercises. One example of a stretching exercise is called the "weighted pendulum stretch," in which a small weight is held in the hand while the arm is allowed to swing back and forth. Other exercises can be used to strengthen the rotator cuff muscles, which increases the support for the shoulder joint.

Steroid injections to the shoulder joint

People with shoulder arthritis whose pain is not well-controlled with pain medications and rest may benefit from steroid injections to the shoulder joint. Steroids can reduce the inflammation in the joint and help relieve pain. Steroid injections may be repeated every few months.

Surgery to repair or replace the shoulder joint

For those with shoulder arthritis that does not respond to other treatments, a physician may recommend surgery to repair or replace the shoulder joint. There are a number of surgical options for treating shoulder arthritis.

• Arthroscopy: Milder cases can be treated with shoulder arthroscopy, in which the surgeon uses small instruments to clean out the inside of the joint.
• Arthroplasty: More severe cases may need to be treated with shoulder joint replacement, or arthroplasty. In arthroplasty, part or all of the shoulder joint bones are removed and replaced with a prosthetic joint. After surgery, your physician will usually recommend a period of physical therapy to help in the recovery of function.

When to seek further consultation for shoulder arthritis

You should see your physician if you experience shoulder pain, limited range of motion, or shoulder swelling. Your physician can perform an examination and order imaging tests to determine if you have shoulder arthritis, then offer the appropriate treatment.