Shoulder Conditions

Shoulder Arthritis

Shoulder Arthritis: Diagnosis, Symptoms and Treatment Options

Shoulder arthritis is a condition where the smooth cartilage that lines the shoulder joint gradually wears away. Cartilage allows the shoulder to move smoothly and without friction. As this protective surface becomes damaged or lost, shoulder movement can become painful, stiff, and increasingly limited.

Arthritis interferes with everyday activities such as reaching overhead, dressing, exercising, or sleeping comfortably.

What Causes Shoulder Arthritis?

The underlying cause of shoulder arthritis varies from person to person. In most cases a clear cause is never identified, and this is referred to traditionally as primary arthritis. When a cause can be identified it is better described as secondary arthritis.

Primary Shoulder Arthritis

Primary shoulder arthritis develops without a clear prior injury or event. Factors that may however increase the likelihood of developing primary arthritis include:

This is usually referred to as primary osteoarthritis

Secondary Shoulder Arthritis

Secondary arthritis occurs when cartilage damage results from an identifiable cause, such as:

Large sized, long standing rotator cuff tears (called rotator cuff arthropathy)
Previous shoulder dislocations or labral tears
Prior shoulder fracture
Previous shoulder surgery
Prior infection within the joint
“Inflammatory” arthritis, usually affecting many joints (e.g. rheumatoid arthritis)
Avascular necrosis

What Causes Shoulder Arthritis?

Primary Shoulder Arthritis

Primary shoulder arthritis develops without a clear prior injury or event. Factors that may however increase the likelihood of developing primary arthritis include:

This is usually referred to as primary osteoarthritis

Secondary Shoulder Arthritis

Secondary arthritis occurs when cartilage damage results from an identifiable cause, such as:

Increasing age, mostly 60-80 years
Previous shoulder dislocations or labral tears
Prior shoulder fracture
Previous shoulder surgery
Prior infection within the joint
“Inflammatory” arthritis, usually affecting many joints (e.g. rheumatoid arthritis)
Avascular necrosis

What Happens to the Shoulder as Arthritis Progresses

As the cartilage wears away the joint surfaces become rough and irregular. Shoulder movement then creates friction, leading to inflammation within the joint, which is the primary source of pain in shoulder arthritis.

As arthritis advances further, continued cartilage loss leads to narrowing of the joint space. Eventually the bones start to rub together – this is often described as “bone-on-bone” arthritis.

In severe cases usually when the arthritis has been present for many years, the bone itself starts to erode away, usually on the socket side of the joint (glenoid). Treatment options become more limited.

Other changes are seen within the joint:

Symptoms of Shoulder Arthritis

Common symptoms of shoulder arthritis include:

Deep, aching shoulder pain
Sharper pain with movement
Night pain that interferes with sleep
Secondary pain and muscle spasm around the shoulder blade and neck
Stiffness : reduced range of motion
Weakness from pain and general disuse of muscles
Difficulty performing daily tasks, sports and other recreational activities

Early in the condition, pain may occur only with specific movements or heavier activity. As arthritis progresses, pain may be present during routine daily activities and at rest. Weakness and functional limitation worsen with duration of the arthritis.

The condition is permanent and generally progresses with time. Heavy physical demands on the shoulder may accelerate the arthritis while modest activity is not known to worsen the condition.

How Shoulder Arthritis Is Diagnosed

Diagnosis involves a combination of clinical assessment and imaging, including:

A detailed medical history and physical examination

X-rays to assess joint space narrowing and alignment

Advanced imaging such as CT or MRI to assess bone quality or rotator cuff integrity

How Shoulder Arthritis Is Diagnosed

Diagnosis involves a combination of clinical assessment and imaging, including:

A detailed medical history and physical examination

X-rays to assess joint space narrowing and alignment

Advanced imaging such as CT or MRI to assess bone quality or rotator cuff integrity

These findings help determine the severity of arthritis and guide treatment decisions.

Non-Surgical Treatment Options for Shoulder Arthritis

Non-operative management is usually the first step in treating shoulder arthritis. The primary goal is to reduce inflammation and manage symptoms.

Treatment options may include:

Activity modification
Ice or heat therapy
Oral anti-inflammatory medications (NSAIDs), where appropriate
Short courses of oral corticosteroids (e.g. prednisolone)
Corticosteroid (cortisone) injections into the shoulder joint (not the bursa)
Biologic injections such as platelet-rich plasma (PRP) in selected cases
Physiotherapy to maintain mobility, improve posture, optimise strength and address maladaptive compensatory movement patterns

While these treatments do not reverse arthritis, many patients experience meaningful symptom relief for extended periods.

Inflammatory arthritis can be managed with a range of medication usually prescribed by a rheumatologist.

Surgical Treatment Options for Shoulder Arthritis

If non-surgical treatments no longer provide adequate relief, surgery may be considered based on symptoms, imaging findings, age, activity level, and rotator cuff function.

Surgical Treatment Options for Shoulder Arthritis

If non-surgical treatments no longer provide adequate relief, surgery may be considered based on symptoms, imaging findings, age, activity level, and rotator cuff function.

Arthroscopic (Keyhole) Surgery

In selected patients, particularly in the younger age group, an arthroscopic procedure may be an option.

This is a minor ‘clean up’ type procedure, and can involve:

Arthroscopic surgery does not restore cartilage or stop arthritis progression, but it may improve pain and movement in selected cases.

Shoulder Replacement Surgery

For more advanced shoulder arthritis, joint replacement surgery may be the most appropriate treatment. This is usually when non-operative measures no longer provide sufficient relief. Occasionally replacement may be required relatively early after the diagnosis is made if bone erosion is severe or use of the arm is very severely limited. Shoulder replacement involves resurfacing the damaged joint surfaces with prosthetic components designed to reduce pain and improve function. The most suitable type of replacement depends on age, bone quality, rotator cuff health, and individual functional requirements.

Options include:

Anatomic total shoulder replacement, which recreates the natural ball-and-socket anatomy and relies on a functioning rotator cuff
Reverse total shoulder replacement, which uses a reversed implant design and is suited to shoulders with significant rotator cuff damage or severe erosion of the bone of the shoulder socket (glenoid)
Partial shoulder replacement, which replaces only the ball of the shoulder joint leaving the existing socket.

Dr Richard Dallalana will carefully assess your shoulder and discuss which option is most appropriate for your condition, including likelihood of success and expected survival of the prosthesis used.

Choosing the Right Treatment for Shoulder Arthritis

The most appropriate treatment for shoulder arthritis depends on multiple factors, including:

Severity of pain
Severity of joint damage
Rotator cuff integrity
Bone quality
Age and activity level
Functional goals and lifestyle demand

You may benefit from specialist assessment if shoulder pain, stiffness, or reduced movement:

Dr Dallalana provides specialised assessment of shoulder arthritis to determine the most suitable management approach based on individual needs.

If you’re experiencing ongoing pain, stiffness, or reduced movement that is affecting your daily activities or quality of life, a thorough orthopaedic assessment can help determine the cause and guide the most appropriate treatment options for your situation.