Shoulder arthritis is the inflammation and deterioration of joint cartilage, leading to significant pain and stiffness. It primarily affects the glenohumeral joint (the ball-and-socket) or the acromioclavicular (AC) joint, where the collarbone meets the shoulder blade. Cartilage breakdown results in bone-on-bone friction, causing discomfort and limiting arm movement. This condition is estimated to affect up to 20% of the older population. Understanding the available treatments, from home care to advanced surgical procedures, is the first step toward improving function and reducing the pain associated with this progressive condition.
Initial Conservative Treatments
Initial treatment focuses on managing pain and inflammation. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen or naproxen, are common over-the-counter options used to reduce pain and the underlying inflammatory process. Topical pain relievers, including creams and gels, offer an alternative way to deliver relief directly to the affected area with fewer systemic side effects.
Activity modification is fundamental, requiring patients to limit movements that aggravate the shoulder, such as repetitive lifting or reaching overhead. Reducing mechanical stress helps prevent flares of acute pain. However, complete immobilization should be avoided, as it can lead to stiffness and weakness over time.
The application of temperature can provide temporary relief. Applying ice helps decrease acute inflammation and numb the painful area. Conversely, moist heat can reduce muscle stiffness and promote relaxation, particularly before light activity. These conservative methods alleviate daily symptoms but do not reverse the physical deterioration of the joint cartilage.
Therapeutic Movement and Strengthening
Once pain is controlled, therapeutic movement is necessary to maintain shoulder function. Physical therapy (PT) focuses on preserving the existing range of motion (ROM) and preventing joint stiffness. A physical therapist develops a customized plan based on the patient’s pain levels and mobility.
Gentle stretching exercises, such as pendulum swings, are introduced first to encourage movement without excessive strain. These passive movements help lubricate the joint and maintain soft tissue length.
The focus then shifts to strengthening the muscles that stabilize the shoulder, particularly the rotator cuff. Strengthening the rotator cuff provides dynamic stability, which reduces stress across the arthritic joint surfaces during movement. Low-impact exercises, such as isometric strengthening, are used to build strength and enhance muscle function, lessening the burden on the damaged cartilage.
Targeted Injections and Specialized Procedures
When pain and stiffness persist despite conservative management, targeted interventions are delivered directly into the joint space. Corticosteroid injections are a common temporary measure, utilizing a potent anti-inflammatory drug to reduce swelling and pain. While they offer short-term relief, the effects are not permanent, and there are limits on how frequently they can be safely administered. Clinicians often use imaging guidance, such as ultrasound or fluoroscopy, to ensure accurate delivery of the medication.
Another specialized procedure is viscosupplementation, which involves injecting a hyaluronic acid solution into the joint. This substance acts as a lubricant and shock absorber. Although more accepted for knee arthritis, it is sometimes used in the shoulder to reduce friction, though its efficacy remains debated.
Emerging biologic treatments, such as Platelet-Rich Plasma (PRP) or stem cell therapy, aim to harness the body’s natural healing factors. These biologics are not yet standardized for shoulder arthritis and are often considered experimental, as current evidence does not prove they can regrow cartilage.
Surgical Solutions for Advanced Arthritis
Surgical intervention is reserved as a last resort for patients with severe, debilitating pain who have failed non-surgical methods. The most common solution for advanced glenohumeral arthritis is shoulder replacement, known as arthroplasty.
A total shoulder arthroplasty (TSA) replaces both the humeral head (ball) and the glenoid (socket) with artificial components. Standard TSA is the gold standard for patients with healthy rotator cuff tendons, providing reliable pain relief and improved function. Alternatively, a hemiarthroplasty replaces only the head of the humerus, leaving the natural socket intact.
The reverse total shoulder arthroplasty (RTSA) is designed for patients with severe arthritis and irreparable rotator cuff damage. The RTSA reverses the normal anatomy, placing the ball component on the shoulder blade and the socket on the upper arm bone. This allows the deltoid muscle to take over the function of the damaged rotator cuff.
A simpler procedure, resection arthroplasty, is often used to treat isolated arthritis of the AC joint. A small section of the collarbone’s end is removed, creating a space that fills with scar tissue, eliminating painful bone-on-bone contact.
For younger, highly active individuals, or those with failed prior replacements, joint fusion (arthrodesis) may be considered. This procedure permanently locks the shoulder joint into a fixed, stable position. Although arthrodesis sacrifices motion, it effectively eliminates chronic pain and provides stability for heavy activities.