Shoulder Osteoarthritis (OA)
1. Introduction
Shoulder osteoarthritis (OA) stereotypically develops after damage to the articular cartilage (smooth connective tissue which covers the end of bones) and surrounding structures within the shoulder. There are two joints in the shoulder. The acromioclavicular joint (ACJ) is formed where your collar bone meets the tip of your shoulder blade (acromion). The glenohumeral joint is formed by the head of your arm bone (humerus) and the outer side of your shoulder blade. Shoulder osteoarthritis is more common in the acromioclavicular joint than in the glenohumeral joint. Almost all of us will develop osteoarthritis in some of our joints as we get older, though we may not even be aware of it.
Frequently Asked Questions
- In shoulder osteoarthritis, the smooth cartilage that covers the ends of the bones gets worn away. This causes the rough bones to rub against each other. This ultimately leads to pain and stiffness in the shoulder.
- Shoulder osteoarthritis typically presents with pain and stiffness in the shoulder.
- It is a common condition but the exact incidence rate is unknown.
- 16%-33% of people aged over 60 have been shown to have shoulder osteoarthritis on X-ray (1, 3).
- People with osteoarthritis can often be asymptomatic, meaning they have no pain or stiffness (6).
- No.
- There is no link to any serious pathology.
- Most people will be able to manage their shoulder pain and improve function without the need for surgery.
- There is no cure for shoulder osteoarthritis but there are many ways to ease pain, preserve mobility and to stay active.
- Non-operative management and surgical management are both effective (4). However, surgery should only be considered if appropriate conservative management has failed.
- Risk increases with age, most common over 50 years of age.
- More common in women than men.
- Those who are overweight.
- Previous shoulder problems.
- Post traumatic arthritis – in younger people that have suffered shoulder trauma such as dislocations.
- Osteoarthritis typically presents as pain and stiffness.
- Pain – usually aggravated by activity and in some cases can progress over time.
- Stiffness – limited movements that can impact upon normal activities of daily living.
- Crepitus – hearing and feeling noises and/or grinding when moving the arm.
- Strength training and flexibility exercises (7).
- Heat or cold therapy.
- Seek input from a musculoskeletal specialist.
- Medication – in tablet form and creams as advised by an appropriate healthcare professional.
- There is no cure for shoulder osteoarthritis but there are many ways to ease pain, preserve mobility and to stay active.
- Acute flare ups usually improve after a few days but can last longer (5).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
2. Signs and Symptoms
The main symptoms of shoulder osteoarthritis are pain, stiffness, reduced strength and limited movement.
Symptoms might progress over time or might come and go; this is often referred to as an acute flare-up (an exacerbation of symptoms does not always mean further joint damage).
The reason for flare-ups is not always clear (5). Some factors reported by patients include:
- Injury to the affected joint or surrounding tissues.
- Excessive or unaccustomed use of a joint.
- Stress.
- Change in medications.
- Cold or wet weather, or a drop in atmospheric pressure.
3. Causes
Shoulder osteoarthritis can be primary or secondary.
- Primary – has no specific cause but is related to age, genes and gender. Primary is usually seen in people over the age of 50 and women are affected more often than men.
- Secondary – has a known cause such as previous injury, history of shoulder dislocations, infection or rotator cuff tears. Certain occupations such as working in heavy construction or participating in sports can also put you at higher risk of developing secondary shoulder osteoarthritis.
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing shoulder osteoarthritis. It does not mean everyone with these risk factors will develop symptoms.
- Age – associated with increased prevalence of age-related degenerative changes.
- Genetics.
- Gender – hormonal changes can make women more susceptible to developing osteoarthritis.
- Weight – increased weight can cause increased inflammation as well as placing more demands upon our joints.
- Joint infection – infection can lead to a cascade of other events which can exacerbate osteoarthritis.
- History of shoulder dislocation and previous injury – makes the joint more susceptible to developing osteoarthritis.
- Occupation – such as heavy construction or overhead sports (2).
5. Prevalence
The prevalence of shoulder osteoarthritis increases with age. It has been reported that approximately 33% of people over 60 years of age have shoulder osteoarthritis, although it is very common to have no symptoms at all (1).
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made.
A thorough assessment from your treating clinician will normally suffice in establishing a suspected working diagnosis of shoulder osteoarthritis. You might be sent for X-rays if the clinician has any concerns about the joint or if you have exhausted appropriate conservative management. However, X-rays produce a level of radiation and thus should only be reserved for appropriate cases.
7. Self-Management
Your musculoskeletal physiotherapist will discuss lifestyle modifications that may help you be more active, lose weight (3) and gain a better understanding of your symptoms. It is a common myth that moving joints will cause them to wear out. In fact, it is quite the opposite; movement is important for preventing the progression of arthritis. Inside your cartilage is a substance called synovial fluid which acts as a lubricant and shock absorber which is heavily aided by regular movement. Your physiotherapist may use the phrase “motion is lotion” which is a nice way of explaining the benefits of getting the joints moving. Possessing this knowledge should give you the reassurance to know that keeping yourself active will not cause further damage.
Your musculoskeletal physiotherapist assists in finding the most enjoyable and suitable exercise for you. Exercise has been shown to be the single most effective way of managing symptoms and if someone is given a diagnosis of osteoarthritis it is important that that person then works to strengthen the joint and help to achieve optimal mobility. Through regular reassessment, your physiotherapist can track your progress and ensure that your exercise plan remains challenging enough for positive changes to occur.
8. Rehabilitation
Building strength and flexibility is important to give you longevity in all the tasks you want to keep doing. We advise consulting with your musculoskeletal physiotherapist prior to trying any of these exercises.
Your musculoskeletal physiotherapist may also use other treatment approaches to help manage your symptoms alongside your exercise programme. They will also provide you with ongoing advice and support to effectively manage symptoms long-term and to reduce, or slow, the progression of symptoms.
Below are three rehabilitation programmes created by our specialist musculoskeletal physiotherapists targeted at addressing shoulder osteoarthritis. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
9. Shoulder Osteoarthritis (OA)
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
This programme aims to carefully begin to increase movement in the shoulder. Pain should not exceed 4/10 on your self-perceived pain scale whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
Here we aim to continue to increase movement but also introduce exercises to start to build the strength of the muscles around the shoulder. Pain should not exceed 4/10 on your self-perceived pain scale whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
This programme progresses the strength exercises from the last programme to further increase the strength and stability of the shoulder. Pain should not exceed 4/10 on your self-perceived pain scale whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain reliving treatments to support symptom relief and recovery. Whilst recovering you might benefit from further assessment to ensure you are making progress and establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.
11. Other Treatment Options
Medications prescribed by your doctor may be helpful in reducing symptoms. This might include a cortico-steroid injection if you have not responded favourably to appropriate conservative management.
Dietary supplements can be taken such as glucosamine and chondroitin. Evidence is conflicting on whether they really help. You should also discuss using these with your doctor due to the possible interactions with other medications.
If non-surgical treatments do not work effectively, there are surgical options available. However, it needs to be carefully considered due to potential side effects such as infection or problems with anaesthesia. These surgical options include:
- Shoulder joint replacement (total shoulder arthroplasty). Replacing the whole shoulder with an artificial joint is usually done to treat arthritis of the glenohumeral joint (4).
- Replacement of the head of the humerus, or upper arm bone (hemiarthroplasty). This option, too, is used to treat arthritis of the glenohumeral joint (4).
- Removal of a small piece of the end of the collarbone (resection arthroplasty). This option is the most common surgery for treating arthritis of the AC joint and associated rotator cuff problems. After the removal of the end of the bone, the space fills with scar tissue (4).
References
- Chillemi, C., & Franceschini, V. (2013). Shoulder osteoarthritis. Arthritis, 2013, 370231. https://doi.org/10.1155/2013/370231.
- Bliddal, H., Leeds, A. R., & Christensen, R. (2014). Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons – a scoping review. Obesity reviews : an official journal of the International Association for the Study of Obesity, 15(7), 578–586. https://doi.org/10.1111/obr.12173.
- Ansok CB, Muh SJ. (2018). Optimal management of glenohumeral osteoarthritis. Orthopaedic research and reviews;10:9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209346/ (last accessed 20.11.2019).
- Soler F, Mocini F, Djemeto DT, et al. (2021). No differences between conservative and surgical management of acromioclavicular joint osteoarthritis: a scoping review. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA. DOI: 10.1007/s00167-020-06377-8.
- Majani G, Giardini A, Scotti A. (2005). Subjective impact of osteoarthritis flare-ups on patients’ quality of life. Health and Quality of Life Outcomes. 2005 Mar;3:14. DOI: 10.1186/1477-7525-3-14.
- Gill, T. K., Shanahan, E. M., Allison, D., Alcorn, D., & Hill, C. L. (2014). Prevalence of abnormalities on shoulder MRI in symptomatic and asymptomatic older adults. International journal of rheumatic diseases, 17(8), 863–871. https://doi.org/10.1111/1756-185X.12476.
- Bunning, R. D., & Materson, R. S. (1991). A rational programme of exercise for patients with osteoarthritis. Seminars in arthritis and rheumatism, 21(3 Suppl 2), 33–43. https://doi.org/10.1016/0049-0172(91)90038-2.
Other Conditions in
Shoulders, Long Term Conditions, Orthopaedics
Whiplash Disorders
An injury which typically occurs following a road traffic collision, often affecting the soft tissues of the neck.
Thoracic Outlet Syndrome
A condition presenting with pain in the arm as a result of compression of structures around the neck/shoulder.
Shoulder Impingement
Shoulder impingement is an umbrella term used to describe a variety of conditions that can cause pain in the shoulder.
Shoulder Dislocation
An injury in which your upper arm bone ‘pops out’ of the cup-shaped socket of your shoulder blade.
Rotator Cuff Tendinopathy
Pain and weakness affecting the shoulder and limiting function.
Frozen Shoulder
An insidious (no clear cause), painful/stiff condition of the shoulder persisting for more than 3 months.
Calcific Tendinopathy
A rare condition causing pain and loss of free movement in tendons and joints.
Biceps Tendinopathy
A tendon-related issue affecting the long bicep tenon at the front of the shoulder.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Acute Torticollis
Sometimes referred to as “wry neck”, this is a condition causing muscle spasms and associated neck pain.
Acromioclavicular Joint Injury
Injury to a small joint at the end of the collar bone (clavicle)/top of your shoulder.