Shoulder Arthritis

Definition

The shoulder is a complex joint, in which the head of the humerus (the “ball”) articulates with the glenoid of the scapula (a shallow “socket”). The surfaces of both are covered by articular cartilage, which allows smooth, painless movement.

In osteoarthritis, this cartilage gradually wears away. As it thins and eventually disappears, the bones begin to rub against each other, causing pain, inflammation and stiffness. At the same time, osteophytes develop and the joint gradually loses its smoothness and its range of motion.

Types and causes

Shoulder arthritis can take various forms and have various causes:

• Primary osteoarthritis: The “classic” degenerative wear that comes with age, with no clear cause.
• Post-traumatic arthritis: Following an old fracture or dislocation of the shoulder.
• Rheumatoid arthritis: An inflammatory disease that affects the joint.
• Rotator cuff tear arthropathy: When a chronic, extensive rotator cuff tear leads to a particular form of arthritis.
• Osteonecrosis: Necrosis of the humeral head due to disruption of its blood supply.

Risk factors include age, family history, previous injuries and heavy, repetitive strain.

Clinical presentation – Symptoms

The symptoms of shoulder osteoarthritis set in gradually and worsen over time:

• Pain, felt deep in the joint and aggravated by movement and activity. It often also gets worse at night, disturbing sleep, particularly when the patient lies on the affected side.
• Stiffness and progressive limitation of the range of motion – difficulty with movements such as combing your hair, getting dressed or reaching behind your back.
• A grinding or “clicking” sensation during movement.
• Muscle weakness of the upper limb, due to avoidance of the painful movement.

Diagnosis

Diagnosis is based on the history, the clinical examination and imaging studies. The Orthopedic Surgeon assesses the character of the pain and the range of motion of the shoulder. X-rays are the basic diagnostic tool, as they demonstrate the narrowing of the joint space, the osteophytes and the other arthritic changes. CT or MRI is used for a more detailed assessment, particularly when surgery is being planned or when the condition of the rotator cuff needs to be evaluated.

Treatment

The treatment of shoulder osteoarthritis is stepwise and is tailored to the stage, the severity of the symptoms and the patient’s needs.

Conservative treatment

In the early and intermediate stages, treatment is conservative and includes activity modification, physiotherapy to maintain range of motion and strengthen the muscles, anti-inflammatory medication for pain control and, in selected cases, injection therapies. Conservative treatment does not reverse the wear, but it can relieve the symptoms significantly and delay the need for surgery.

Surgical treatment

When the arthritis is advanced and the symptoms do not respond to conservative treatment, the indicated solution is shoulder arthroplasty, i.e. replacement of the worn surfaces with artificial implants. Depending on the condition of the rotator cuff and the characteristics of each case, the appropriate type of arthroplasty (anatomic or reverse) is selected. Shoulder arthroplasty offers substantial pain relief and improved function.

Before and after treatment

Before treatment, a patient with advanced shoulder arthritis lives with chronic pain, discomfort at night and severe restriction of movement, which makes simple everyday activities difficult. After appropriate treatment – conservative or surgical – and completion of rehabilitation, most patients regain pain-free movement and the function of the upper limb.

How it affects everyday life

Although the shoulder is not a weight-bearing joint, its function is crucial for almost every activity of the upper limb. Advanced shoulder arthritis therefore has a profound effect on independence: getting dressed, combing your hair, washing, reaching for an object on a shelf, even driving, gradually become difficult and painful.

Night pain is particularly troublesome, as it disturbs sleep and lowers overall quality of life. It is this combination of pain and functional limitation that ultimately prompts most patients to seek a definitive solution, when conservative treatment is no longer enough.

The role of physiotherapy

Physiotherapy is a cornerstone of both conservative treatment and rehabilitation after arthroplasty. A well-designed programme focuses on maintaining and improving range of motion, on strengthening the muscles that support and move the shoulder – particularly the rotator cuff and the deltoid – and on improving the function of the upper limb.

Regular, guided exercise relieves the symptoms and can slow the progression of the disease. It is important that the exercises are individualised, which is why working with a specialised physiotherapist, under the guidance of the Orthopedic Surgeon, is of real value.

Prevention

Although osteoarthritis cannot always be prevented, certain measures can reduce the risk or slow its progression: avoiding excessive, repetitive strain on the shoulder, timely and proper treatment of injuries (fractures, dislocations, rotator cuff tears), maintaining good muscle condition and regular, gentle exercise.

Differential diagnosis: not every shoulder pain is arthritis

Shoulder pain is one of the most common orthopedic symptoms and can be due to many different conditions – not only arthritis. A rotator cuff tear, subacromial impingement syndrome, frozen shoulder and calcific tendonitis can cause similar symptoms.

Telling them apart correctly is crucial, as each condition is treated differently. Sometimes, indeed, the conditions coexist – for example, arthritis may be accompanied by a rotator cuff tear. This is why a specialist orthopedic assessment, combined with the appropriate imaging studies, is essential for the correct diagnosis and for drawing up the appropriate treatment plan.

Cost of treatment

The cost depends on the type of treatment (conservative or surgical) and, in the case of surgery, on the type of arthroplasty, the implant materials, the hospital and the class of room, as well as insurance cover. In most cases of arthroplasty, private insurance policies and insurance funds cover a significant part of the expense.

Precise information is given on an individual basis, after the clinical assessment. The clinic is at your disposal for any relevant information.

More about the factors that determine the cost and about cover by insurance funds: Cost of surgery.

Stages and progression of the disease

Shoulder osteoarthritis progresses gradually. In the early stages, the cartilage wear is mild and the symptoms are intermittent, appearing mainly after activity. In the intermediate stages, the pain becomes more frequent and the stiffness more marked. In the final stages, the cartilage has been almost completely destroyed, the pain is constant and function is severely limited.

The stage of the disease also largely determines the treatment approach: the earlier it is diagnosed, the more numerous and more effective the conservative options are. This is why timely assessment of persistent shoulder pain matters.

Frequently asked questions

Is shoulder arthritis common?

It is less common than arthritis of the knee or the hip, as the shoulder is not a weight-bearing joint. However, when it does occur, it can seriously affect the function of the upper limb.

Where does shoulder arthritis hurt?

The pain is felt deep in the joint and gets worse with movement and often at night too, particularly when the patient sleeps on the affected side.

Do I definitely need surgery?

Not necessarily. In the early and intermediate stages, conservative treatment can provide significant relief. Arthroplasty is indicated when the arthritis is advanced and the symptoms cannot be controlled conservatively.

Does physiotherapy help?

Yes. Physiotherapy maintains range of motion, strengthens the muscles that support the shoulder and relieves the symptoms, and is a key part of conservative treatment.

Is the cost covered by insurance?

In most cases of arthroplasty, private insurance policies and insurance funds cover part or all of the expense. The clinic can give you detailed information.

When should I see an Orthopedic Surgeon?

If you have persistent shoulder pain, discomfort at night, progressive stiffness or difficulty with everyday movements that affect your quality of life, it is advisable to be assessed by a specialist Orthopedic Surgeon, so that the appropriate treatment can start in good time.