Shoulder Arthritis Symptoms & Treatment

If your shoulder feels stiff, sore or is hard to move, it could be more than everyday aches and pains. It could be shoulder arthritis, a common cause of shoulder pain, especially as we age. Left untreated, it can slowly wear down the joint and make everyday movements hard.

“Shoulder arthritis is the breakdown of cartilage in the joint,” said Ryan Nixon, MD, an independent shoulder and knee surgeon who chooses to practice at Franciscan Health. “When that cartilage wears out, the bones rub together, which causes pain and stiffness.”

What Causes Shoulder Arthritis?

There are a few different types of arthritis that can affect the shoulder.

• Osteoarthritis, also called primary arthritis, is the most common type. It results from wear and tear over time. It is more common in those who do a lot of physical labor for work or use their arms and shoulders for overhead activity. Genetics also plays a role, Dr. Nixon said.
• Rheumatoid arthritis is an autoimmune disease where the body attacks its joint lining.
• Post-traumatic arthritis can happen after a previous shoulder injury, even years later.
• Rotator cuff arthropathy is a combination of a rotator cuff tear and arthritis that changes the structure of the joint.

Regardless of the cause, the result is the same: joint pain and less comfortable movement.

What Are The Signs Of Shoulder Arthritis?

Shoulder arthritis usually starts mild and slowly gets worse over time. You might notice:

• Deep, aching shoulder pain
• Stiffness, especially in the morning or after rest
• Pain with movement or while you sleep
• A grinding or popping feeling when you move your arm
• Trouble lifting your arm overhead

“It initially starts with just a little bit of central wear of the cartilage,” Dr. Nixon said. “But over time, the joint breaks down and you start to get bone spurs in the mild stage. Those spurs get bigger in the moderate phase, and you lose more joint space. As it gets worse, the humeral head starts to collapse and flatten. These structural changes can cause more pain and stiffness and make everyday movements very hard.”

How Is Arthritis Diagnosed?

Diagnosing arthritis starts with a physical exam and a conversation about your symptoms, medical history and how the pain affects your life. Imaging, such as X-rays, can show narrowing of the joint space, bone spurs or changes to the bone.

“If we suspect soft tissue damage, like a rotator cuff tear alongside the arthritis, we may also order an MRI,” Dr. Nixon said.

What Are the Treatment Options for Shoulder Arthritis?

The best treatment depends on how bad the arthritis is and how much it impacts your life. In most cases, surgery isn’t the first option.

Nonsurgical treatment options

“We’ll start with nonsurgical treatment options for many,” Dr. Nixon said. This includes:

• Activity changes: Avoid overhead motion or anything that makes the pain worse. Try to focus on movements that don’t aggravate the joint.
• Anti-inflammatory medicines: Over-the-counter or prescription options can reduce swelling and help manage pain.
• Steroid injections: These reduce inflammation and can provide temporary relief during a flare-up. On average, steroid injections offer about three months of pain relief, though some people may get more and others less. “They usually work well for the first couple of times,” Dr. Nixon said, “but they tend to be less effective over time.” Repeated injections can weaken the soft tissues and reduce bone quality. “I don’t recommend using them as a long-term solution. If you return every few months for another shot, it may be time to consider a different plan.”
• Physical therapy: Targeted physical therapy exercises can help improve strength and maintain range of motion. However, they are most useful in the early stages of arthritis or for patients who aren’t good candidates for surgery. “As you get into the more advanced stages, it’s just not going to help,” Dr. Nixon said. “It’s not a muscular problem — it’s an arthritis problem — and therapy can sometimes make things worse.”
• Platelet-rich plasma (PRP) therapy: We take a small amount of your blood, spin it to separate the platelets rich in healing growth factors, and inject it into the shoulder. PRP may help with early-stage arthritis (grades 1–2) and certain tendon-related issues like tendonitis. “PRP is not as effective in more advanced arthritis, but it may be an option to explore in the earlier phase,” said Dr. Nixon.

Surgery for shoulder arthritis

If pain doesn’t improve or gets worse despite nonsurgical care, surgery may be the next step, especially for advanced arthritis. “The mainstay of treatment for advanced shoulder arthritis is shoulder replacement,” Dr. Nixon said.

There are a few types of shoulder replacements, each with a specific purpose:

• Hemi or partial shoulder replacement: The surgeon only replaces the humeral head (the ball). This may be an option when damage is limited to one part of the joint.
• Anatomic shoulder replacement: The surgeon replaces both sides of the joint. A metal ball replaces the humeral head, and we place a plastic insert in the socket (glenoid). “You can’t see the plastic part on an X-ray, but it creates a smooth space between the bone and the implant,” Dr. Nixon explained. “This option works best when the rotator cuff is intact and functioning.”
• Reverse shoulder replacement: We use this procedure when the rotator cuff is torn or no longer functional. “The rotator cuff’s main job is to keep the ball stable in the socket,” Dr. Nixon said. “When it’s torn, the joint moves abnormally. Over time, it causes more wear and bone damage. That’s called rotator cuff arthropathy.”

Shoulder replacement, whether anatomic or reverse, helps to reduce pain and restore movement. “It’s one of those surgeries where people often say, ‘Why didn’t I do this sooner?’”

What Does Recovery Look Like?

Most people wear a sling for a few weeks. Full recovery takes a few months, but the improvement in pain and mobility is often noticeable early on. “It’s a process,” Dr. Nixon said, “but we guide you through every step.”

Don’t let shoulder arthritis limit your life. Whether you need an injection or are considering joint replacement, treatments help you move comfortably again. Franciscan Health and our orthopedic partners are here to help.