What is shoulder osteoarthritis?

Shoulder osteoarthritis is a degenerative joint condition that occurs when the cartilage cushioning the ends of the joints in the shoulder wears down over time. This condition primarily affects the glenohumeral joint (where the arm connects to the shoulder) and the acromioclavicular joint (where the collarbone meets the shoulder blade). As the cartilage deteriorates, the bones can rub against each other, causing pain, stiffness, and reduced mobility.

There are two types of shoulder osteoarthritis:

• Primary osteoarthritis: This type occurs due to age-related wear and tear of the joint cartilage.
• Secondary osteoarthritis: This type results from an underlying condition or injury, such as a previous shoulder dislocation or fracture, inflammatory arthritis, or rotator cuff tear.

What are the symptoms of shoulder osteoarthritis?

Symptoms of shoulder osteoarthritis can vary in intensity and may develop gradually over time. Common symptoms include:

• deep, aching pain in the shoulder, which may worsen with activity and improve with rest
• joint stiffness and limited range of movement
• joint swelling and inflammation
• a feeling of grinding, clicking, or popping during shoulder motion
• a sense of weakness or instability in the shoulder

What causes shoulder osteoarthritis?

The exact cause of cartilage deterioration in shoulder osteoarthritis is still unknown. However, several factors can contribute to the development of the condition, including:

• Age: As we get older, the cartilage in the shoulder joint naturally wears down.
• Genetics: A family history of osteoarthritis can increase the risk of cartilage degeneration.
• Previous injuries: Shoulder injuries, such as fractures, dislocations, or rotator cuff tears, can damage the joint and lead to osteoarthritis. Even after healing, these injuries can cause changes in the joint that increase the risk of shoulder osteoarthritis.
• Repetitive use: Repeated stress and overuse of the shoulder joint, often due to certain occupations or sports that involve repetitive shoulder movements, can contribute to the development of shoulder osteoarthritis.

How is shoulder osteoarthritis diagnosed?

The specialist will start by taking a comprehensive medical history, which includes details about previous shoulder injuries, symptoms, and any family history of arthritis.

A physical examination will then assess range of motion, areas of tenderness or swelling, strength and steadiness of the shoulder joint, and the presence of grinding, clicking, or popping sensations during movement.

Subsequently, imaging studies will be ordered to help confirm the diagnosis and evaluate the extent of joint damage. Common imaging tests include:

• X-rays: The most common imaging test for diagnosing osteoarthritis. X-rays can reveal joint space narrowing, bone spurs, and changes in bone structure.
• MRI: An MRI provides detailed images of soft tissues, including cartilage, tendons, and ligaments.
• CT scan: A CT scan offers detailed cross-sectional images of the bones and can be helpful in complex cases.

In some cases, additional tests such as blood tests or joint aspiration (arthrocentesis) may be needed to rule out other conditions and assess the overall health of the joint.

How is shoulder osteoarthritis treated?

Treatment for shoulder osteoarthritis aims to relieve pain, improve function, and enhance quality of life. Treatment may involve:

• Lifestyle modifications: Lifestyle adjustments include avoiding activities that worsen pain and adapting daily tasks to reduce strain on the shoulder joint.
• Physical therapy: Physiotherapy includes exercises to improve range of motion, strengthen shoulder muscles, and enhance joint stability.
• Medications: Over-the-counter pain medications like non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. Likewise, topical creams or gels containing NSAIDs can also provide localised pain relief.
• Corticosteroid injections: Injections directly into the shoulder joint can reduce inflammation and provide temporary pain relief.

If conservative treatments fail to alleviate symptoms, surgical options may be considered, such as:

• Shoulder arthroscopy: Shoulder arthroscopy is a minimally invasive procedure where a small camera and instruments are inserted into the shoulder joint to remove loose cartilage, bone spurs, or inflamed tissue.
• Shoulder resurfacing: Shoulder resurfacing is a less invasive alternative to total shoulder replacement, where only the damaged parts of the joint are replaced with metal implants.
• Total shoulder replacement (arthroplasty): Total shoulder replacement entails replacing the damaged joint surfaces with artificial components known as prosthetics. This procedure is usually recommended for severe cases where there is extensive joint damage.

Can shoulder osteoarthritis be prevented?

While it may not be possible to prevent shoulder osteoarthritis entirely, certain strategies can reduce its risk or delay its onset. These measures include:

• Maintaining a healthy weight: Excess weight can increase stress on the shoulder joints.
• Exercising regularly: Engaging in exercises that strengthen shoulder muscles and maintain joint flexibility, such as swimming or low-impact aerobics.
• Protecting the shoulder: Using protective gear during sports or activities that pose a risk of shoulder injury.

Which specialist treats shoulder osteoarthritis?

Various specialists may be involved in the diagnosis and treatment of shoulder osteoarthritis, including orthopaedic surgeons, rheumatologists, and physical therapists.