Shoulder Osteoarthritis

The initial treatment for shoulder arthritis is medical (non-operative) treatment. It often starts with range-of-motion exercises to keep the shoulder mobile. If your range of motion is not affected, then the goal is to prevent it from deteriorating.

Loss of motion in the shoulder joint due to arthritis is often gradual and can be hard to notice. As the joint gets stiffer, the pain and the ability to be active may also worsen. It is recommended to stretch for two to three minutes every day, whether you have a loss of motion or not.

Physiotherapy for shoulder arthritis is typically not needed unless you are losing range of motion. Strengthening the shoulder with arthritis is usually not recommended, as in some instances it could cause more pain. However, if exercises do not bother the shoulder, then they are perfectly fine to do.

Targeted exercises can strengthen the muscles around the shoulder, including the rotator cuff and scapular stabilisers. This can improve stability, reduce pain, and help maintain shoulder function for daily activities such as reaching, lifting or dressing.

The second medical treatment is to avoid, within reason, the things that make the shoulder painful. Generally, anything that causes pain should be avoided, especially if the pain interferes with your life. If shoulder pain lasts for several days and wakes you up at night, it may be reasonable to question how important that activity is to you. For example, if you have pain while playing golf, it may be necessary to cut down to once a week instead of playing daily.

Changing how you move or perform tasks can reduce stress on the shoulder joint. This may include rest or avoiding heavy lifting, pacing activities, using ergonomic equipment or modifying overhead movements.

The third medical treatment is to try to control the pain. This can be done in several ways:

• Ice is your friend. Ice packs are great for pain and can be used once or several times a day if needed. You can use a bag of ice or a cold therapy pad that can be placed in the freezer and reused. The ice pack should be placed on the front, across the top and on the back of the shoulder. It can be used for 20-30 minutes at a time. If the pain is waking you up at night, consider icing the shoulder before bed.
• Some people feel that heat is a better treatment for shoulder arthritis pain. Heat is often good for warming up the joint before stretching, but you should use whatever strategy provides the best relief.
• Medication can also be used to control pain, but all of them have their benefits and potential complications. Discuss your medications with doctor or your surgeon to make sure you don’t have any reasons to avoid certain medications.

Pain and inflammation can be managed with medications such as paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) or other prescription options depending on individual needs. Always speak to your doctor or pharmacist before taking these medicines as they may be harmful to some people.

For persistent symptoms, injections may provide relief:

There are currently two types of injections that can provide pain relief for shoulder arthritis. The first type is cortisone shots. Typically, cortisone is mixed with a numbing agent that provides immediate pain relief and helps your doctor know if the injection is in the right place. Once the numbing medicine wears off, the joint may be sore until the cortisone kicks in. It is important to ice the shoulder for a day or so after the shot.

Cortisone shots don’t damage the shoulder, but most surgeons limit them to no more than a few a year in most cases of arthritis. Cortisone shots may increase the risk of infection if you undergo a total shoulder replacement soon after the shot. If you are considering the surgery, consider avoiding cortisone shots a few months prior.

The current recommendation is not to have shoulder replacement surgery within three months of having a cortisone shot in the shoulder. If you are considering surgery, it is best to avoid cortisone shots until you have discussed it with your doctor.

The other medicine that can help with shoulder arthritis is synthetically manufactured hyaluronic acid. It’s a naturally occurring lubricant in the human body. This liquid substance has been injected into arthritic knees for many years. This injection sometimes helps with the pain for up to two years, but it is unusual for it to take all the pain away for an extended period of time.

Platelet-rich plasma (PRP) injections may support tissue healing and reduce pain, although evidence is still emerging.

There’s a range of different splints, braces and supports available for painful joints. These can be particularly helpful if osteoarthritis has affected the alignment of a joint. It’s best to seek professional advice from before choosing one, so you can be sure it’s suitable for your needs.

Most people with shoulder osteoarthritis won’t need surgery and it’s usually only considered if all non-surgical treatments have failed. In this case we will be able to refer you to and orthopaedic surgeon to discuss your options.

If non-surgical treatments are no longer effective, surgical options may be considered:

Arthroscopic Shoulder Debridement – this minimally invasive procedure uses a small camera (an arthroscope) and surgical tools inserted through small incisions to “clean out” (debride) the shoulder joint. It is recommended for patients with lower grades of arthritis and is typically not recommended when there is bone-on-bone traction.

If you have some cartilage left in the joint, sometimes debridement can provide pain relief. No bone spurs are removed during this procedure, as the spurs are the result of arthritis and not the cause. This operation is considered a success if it relieves pain for 12 to 24 months. Although in some cases the pain relief may last longer, this operation is typically not a permanent solution for shoulder arthritis as it does not change the presence of the disease.

Shoulder replacement (partial or total) – shoulder replacement is the preferred procedure for bone-on-bone shoulder arthritis. It relieves the pain of arthritis, and it has been shown to last for many years.

A standard total shoulder replacement procedure replaces the ball and the socket parts of the shoulder joint with artificial parts.

In a reverse total shoulder replacement procedure, the ball and socket sides of the joint switch places. This procedure can be done for many conditions, but it’s mainly used when there is a rotator cuff tear in the shoulder with arthritis.