Shoulder arthritis occurs when the smooth cartilage covering the ends of the bones in the joint wears down, causing pain and stiffness. The two primary forms are osteoarthritis, a “wear-and-tear” condition where cartilage deteriorates over time, and rheumatoid arthritis, an autoimmune disease attacking the joint lining. As the condition progresses, bones may rub together, causing a grinding sensation (crepitus) that limits motion and interferes with daily activities like reaching or dressing. Treatment aims to manage pain, reduce inflammation, and restore function, ranging from self-care to surgical procedures.
Immediate Self-Care and Daily Adjustments
Managing shoulder arthritis begins with simple, immediate self-care practices. Rest is an important initial step, involving the avoidance of movements that aggravate pain, especially repetitive overhead lifting. Balancing rest with gentle movement is necessary to prevent the joint from becoming overly stiff.
Applying temperature therapy can offer immediate relief, though the choice between heat and cold depends on the symptom. Cold application, such as an ice pack for 10 to 20 minutes, is effective for reducing inflammation and numbing acute pain, particularly after activity. Conversely, heat therapy, using a heating pad or warm shower, helps relax tight muscles and ease joint stiffness, making it useful before movement or in the morning.
Activity modification protects the shoulder joint from unnecessary stress. Simple adjustments, like using assistive devices for reaching high shelves or changing sleep positions to avoid lying on the affected shoulder, minimize discomfort throughout the day. Being mindful of posture and avoiding movements that cause sharp pain helps preserve the joint.
Pharmacological Relief and Injections
Over-the-counter (OTC) medications are often the first line of pharmacological treatment to address pain and inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, work to reduce both pain and inflammation in the joint. Acetaminophen is another OTC option that focuses purely on pain relief and may be preferred by individuals who cannot tolerate NSAIDs due to stomach issues.
For more intense symptoms, a healthcare provider may prescribe stronger medications or specific treatments. For inflammatory conditions like rheumatoid arthritis, disease-modifying antirheumatic drugs (DMARDs) or biologic agents may be used to slow the progression of the disease by targeting the immune system. Topical creams containing ingredients like capsaicin can also be applied directly to the skin over the joint to block pain signals.
When oral medications are insufficient, therapeutic injections offer a targeted approach to pain management. Corticosteroid injections deliver a powerful anti-inflammatory medication directly into the joint space, which can provide pain relief lasting for several months. These injections are typically limited to a few times a year due to potential side effects like weakening of the joint structure with frequent use.
Viscosupplementation involves injecting hyaluronic acid, a substance naturally found in joint fluid, into the shoulder. This procedure is intended to increase the viscosity and lubrication of the joint fluid, potentially improving gliding motion. However, the use of hyaluronic acid and other regenerative treatments like platelet-rich plasma (PRP) in the shoulder is still being studied for long-term efficacy.
Structured Rehabilitation and Therapeutic Movement
Structured physical therapy (PT) is a significant component of non-surgical management, focusing on restoring function and improving the long-term health of the shoulder. The primary goals of a prescribed rehabilitation program are to increase the shoulder’s range of motion and strengthen the muscles that support the joint. A physical therapist tailors a program to the individual, ensuring exercises are gentle and do not exacerbate existing pain.
Range of motion exercises are crucial for maintaining joint flexibility, which can otherwise be severely limited by arthritis-related stiffness. Gentle stretches, such as pendulum exercises where the arm hangs and swings freely, help promote relaxation and increase mobility without stressing the joint surfaces. Other exercises like wall climbs gradually work to restore the ability to lift the arm overhead.
Strengthening the muscles surrounding the shoulder, particularly the rotator cuff, provides better support and stability for the arthritic joint. Therapists often incorporate exercises like shoulder blade squeezes and isometric pushes against a wall to build muscle strength and improve posture. Strengthening the supportive musculature helps to reduce the forces placed directly on the worn cartilage surfaces.
In addition to prescribed exercises, physical therapists may use various modalities to enhance the overall treatment effect. Manual therapy, which includes hands-on joint mobilization and soft tissue massage, helps to improve movement and relieve pain by gently stretching tight ligaments and muscles. Professional application of heat and cold, or therapeutic ultrasound, can be used to prepare the joint for exercise or calm down inflammation afterward.
Advanced Medical and Surgical Procedures
When conservative treatments no longer provide adequate pain relief or function, advanced surgical procedures become necessary. Arthroscopy is a minimally invasive surgical option often considered for early-stage arthritis. This procedure involves inserting a small camera and instruments through tiny incisions to clean out the joint, remove bone spurs, or debride damaged cartilage.
For individuals with severe joint destruction, shoulder joint replacement (arthroplasty) offers a definitive solution. A total shoulder replacement replaces both the ball and the socket with artificial components, typically performed when the rotator cuff tendons are healthy. A reverse total shoulder replacement is designed for patients with severe arthritis who also have a non-functional rotator cuff, switching the position of the ball and socket to allow other muscles to move the arm.
Joint fusion, or arthrodesis, is reserved for cases where other options are not viable or the joint is severely unstable. This surgery permanently fuses the bones of the shoulder joint together, eliminating motion but providing lasting pain relief and stability.