Shoulder Arthritis
What Causes Chronic Shoulder Pain and Stiffness?
Ongoing shoulder pain and stiffness that gradually worsens over time, especially with overhead reaching or lying on that side at night, is often shoulder arthritis — cartilage wear at the ball-and-socket joint that can develop from age, prior injury, or long-standing rotator cuff problems. It's a common cause of chronic shoulder pain, and treatment ranges from simple activity changes to joint replacement, depending on severity.
What's Actually Happening in the Joint
The shoulder is a ball-and-socket joint, with smooth cartilage covering both the head of the arm bone and the socket to allow pain-free motion. Osteoarthritis develops when that cartilage gradually wears down, causing bone to rub against bone. Shoulder arthritis can also develop secondary to a long-standing, untreated rotator cuff tear — a pattern called cuff tear arthropathy — which behaves somewhat differently and often changes the surgical options available.
Symptoms
Deep, aching shoulder pain that worsens with activity and often at night
Progressive stiffness and loss of motion, especially reaching overhead or behind the back
A grinding, catching, or grating sensation with shoulder movement
Weakness that may develop as pain limits use of the arm over time
Diagnosis
X-rays are typically the first step and often show the characteristic joint space narrowing and bone changes of arthritis. Additional imaging, such as MRI, may be used to evaluate the rotator cuff's condition, which is an important factor in deciding between different surgical options if surgery becomes necessary.
Treatment Options
Nonsurgical:
Activity modification, physical therapy to maintain motion and strength, anti-inflammatory medication, and corticosteroid injections — often effective for milder arthritis or as a way to delay surgery.
Surgical:
When nonsurgical treatment no longer provides adequate relief, joint replacement is the definitive treatment. The specific type depends largely on whether the rotator cuff is intact: an anatomic total shoulder replacement is used when the rotator cuff is healthy and functioning, while a reverse shoulder replacement is used when the rotator cuff is significantly damaged or torn, since it relies on the deltoid muscle instead of the cuff to move the arm.
Frequently Asked Questions:
Does shoulder arthritis always get worse over time?
It's typically a progressive condition, though the rate varies significantly between patients — some remain stable for years with conservative management, while others progress more quickly.
How do you decide between anatomic and reverse shoulder replacement for arthritis?
The condition of the rotator cuff is the key factor — an intact, functioning cuff generally favors an anatomic replacement, while a significantly torn or nonfunctional cuff favors a reverse replacement.
Can shoulder arthritis be managed without surgery long-term?
Many patients manage well for extended periods with activity modification, therapy, and injections, particularly with milder arthritis; surgery becomes the better option once these measures no longer control symptoms.