Shoulder joint arthritis

What is shoulder joint arthritis?

The shoulder is made up of three bones:

• the scapula (shoulder blade)
• the humerus (upper arm bone)
• the clavicle (collarbone)

The part of the scapula that makes up the socket of the shoulder joint is called the glenoid. The ball and socket joint where the glenoid (scapula) and the humerus join is the shoulder (glenohumeral) joint.

The most common cause of shoulder joint arthritis is 'joint wear' called osteoarthritis (OA). This is where the smooth cartilage surface covering the joints becomes thin and rough. The ends of the bone can then rub together causing pain.

Why does it occur?

Most of the time there is no obvious cause for this but it can develop due to an injury. Underlying inflammatory joint disease such as rheumatoid arthritis, shoulder tendon deficiency (rotator cuff) and people with underlying neurological problems may also be affected.

How common is it?

It is a common condition among people aged 60 years and older.

What are the symptoms?

The main symptoms are:

• pain around the shoulder and upper arm, possibly affecting sleep
• restricted movement of the shoulder, which can affect daily activities

What you can do to help yourself

There is no cure for arthritis. However, there are several things that will improve your pain. The pain may never go away completely but painkillers and exercise regimes are important to bring your symptoms to a manageable level.

Pain relief

There is strong evidence that simple painkillers and anti-inflammatory tablets significantly help people to manage the pain. Simple medicines such as paracetamol when taken regularly can greatly reduce the pain you feel. For most people these medicines are safe and have little side effects. If you need stronger painkillers you should discuss this with your pharmacist or GP to get the right medicine for you.

If you don’t like taking medicine, then you could try applying anti-inflammatory cream over the tender area. You should check with your pharmacist or GP to ensure you have no contraindications to these painkillers.

Some people find that heat and cold application helps. For heat, you can try a hot water bottle. For cold, try an ice pack or ice wrapped in cloth. Please be careful not to apply hot or cold packs directly to the skin as they can damage your skin if not used correctly.

Physiotherapy

It's important to get your pain under control and to keep as much movement in the shoulder as possible. This keeps the muscles strong and nourishes the joint surface. Simple exercises may help prevent your shoulder from stiffening up.

See some appropriate exercise management at the Chartered Society of Physiotherapy. We would encourage you to try the exercises daily to strengthen your shoulder and help settle down the pain.

These exercises are a good starting point, but sometimes additional physiotherapy is required. The majority of shoulder problems get better if you complete the exercises daily. However, it should be appreciated that it can take a number of months of regular exercise to improve.

General exercise

Many people with shoulder pain are worried that exercise will cause further damage to the area. However, shoulders are designed to move - inactivity is harmful to the tissues around the joint and can cause stiffness and weakness. Therefore maintaining movement within the limits of your pain is important.

Exercise will also have a positive effect on general fitness. This is best done in liaison with your physiotherapist or GP.

It has also been found that exercising other areas of the body can improve the function of your painful shoulder, so general exercise such as walking, swimming or cycling is encouraged in addition to your specific shoulder exercises.

What are other treatment options?

Injections

Local anaesthetic and steroid (cortisone) injections into the joint can be tried. They can be given by some GPs or specialist physiotherapists. They are not a cure but can improve pain if you are experiencing a particularly bad flare of symptoms. They should be used in conjunction with the exercise regime.

It's advised that no more than three injections should be given due to possible negative effects steroids can have on the tendons in the shoulder.

Keyhole (arthroscopic) surgery

This aims to tidy up the shoulder joint, offered in certain situations. This tends to only be offered to young active people who are not advised to have a joint replacement. The aim is to try to get fibrous tissue to form in the joint by micro-fracturing the joint surface. It is not done frequently; its effectiveness varies between individuals and is only offered in certain scenarios.

Shoulder joint replacement

There are different types of joint replacement depending on the type of arthritis and the damage it has done in the shoulder. The aim of the operation is to improve your pain. In some cases, it can improve your shoulder movement, but not always.

On average there is only a modest improvement in movement after a shoulder replacement, and it may not improve at all. This operation is usually only suitable for older people as shoulder replacements may only last 10 years.