What is shoulder arthritis?
Shoulder arthritis is a condition where the smooth cartilage that covers the ends of the bones in the shoulder joint gradually wears away, leading to pain, stiffness, and reduced movement. The shoulder is a ball-and-socket joint formed by the humeral head and the glenoid of the scapula, and when cartilage deteriorates, these bones begin to rub directly against each other, causing inflammation and joint damage. The most common form is osteoarthritis which develops slowly over time, but it can also result from previous injury, chronic shoulder instability, or inflammatory conditions such as rheumatoid arthritis. People with shoulder arthritis often experience deep, aching pain that worsens with activity, stiffness that limits overhead or rotational movements, and sometimes grinding or clicking sensations known as crepitus. As the condition progresses, it can significantly affect daily activities such as dressing, reaching, or lifting objects.
Causes
The most common cause is osteoarthritis from long-term “wear and tear” on the joint. Previous shoulder injuries, such as fractures, dislocations, or rotator cuff tears, can also accelerate cartilage breakdown by altering normal joint mechanics and increasing stress on certain areas. Inflammatory conditions like rheumatoid arthritis may cause arthritis through ongoing immune-mediated inflammation that damages cartilage and surrounding joint structures. Repetitive overhead activity or heavy manual work can contribute in some cases by placing chronic load on the joint, while genetic factors and individual variations in cartilage quality may also increase susceptibility. As the cartilage deteriorates, bone-on-bone contact develops, leading to pain, stiffness, and progressive joint degeneration.
Symptoms
Deep, aching shoulder pain: A constant or intermittent pain felt inside the joint that often worsens with activity and improves with rest in the early stages
Stiffness of the shoulder: Reduced ability to move the arm, especially when reaching overhead, behind the back, or rotating outward
Reduced range of motion: Progressive loss of movement in all directions due to joint degeneration and stiffness of the surrounding tissues
Grinding or clicking (crepitus): A rough, crunchy sensation or sound during movement caused by bone-on-bone contact and irregular joint surfaces
Pain at night: Discomfort that can worsen when lying on the affected shoulder, often disturbing sleep
Weakness in the shoulder: Loss of strength due to pain, stiffness, and reduced ability to use the joint normally
Swelling or tenderness: Mild swelling or sensitivity around the joint may occur, especially during flare-ups of inflammation
Difficulty with daily activities: Tasks such as dressing, reaching overhead, or lifting objects become increasingly challenging as the condition progresses
Diagnosis
Your surgeon will first taking a detailed history of symptoms, such as progressive deep shoulder pain, stiffness, reduced range of motion, and difficulty with daily activities like reaching or dressing.
This is followed by a physical examination to assess movement in all directions and to identify signs such as crepitus, pain at the end range of motion, and overall loss of shoulder flexibility.
Imaging
To confirm the diagnosis and assess severity, imaging is essential. X-rays are usually the first-line investigation and can show key features of arthritis, including joint space narrowing, bone spurs (osteophytes), and changes in bone shape. In more complex cases or when surgical planning is needed, a CT scan may be used to provide detailed information about bone structure and joint wear, while an MRI can help evaluate surrounding soft tissues such as the rotator cuff and detect associated conditions that may influence treatment decisions.
Treatment
Conservative (Non-Operative)
Conservative management of shoulder arthritis aims to reduce pain, maintain joint function, and slow progression of symptoms. Treatment usually begins with activity modification, such as avoiding or reducing repetitive overhead movements and heavy lifting that aggravate pain. Simple pain relief measures, including paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), may be used to control discomfort and inflammation. Physiotherapy plays a key role and focuses on maintaining shoulder range of motion through gentle stretching, as well as strengthening the rotator cuff and scapular muscles to improve joint stability and function. Heat or cold therapy can also help relieve stiffness and pain. In some cases, corticosteroid injections into the shoulder joint may be used to provide temporary relief of inflammation and allow better participation in rehabilitation. Education about pacing activities and adapting daily tasks is also important to help patients manage symptoms and maintain independence for as long as possible.
Surgical treatment
The most common and effective procedure is shoulder replacement (arthroplasty), which involves replacing the damaged joint surfaces with artificial components. This can be performed as a total shoulder replacement, where both the humeral head and the glenoid are replaced, or as a partial (hemi) replacement, where only the humeral head is replaced, though this is used less frequently. In cases where the rotator cuff is severely damaged or non-functional, a reverse shoulder replacement may be performed, which changes the mechanics of the joint to allow other muscles, particularly the deltoid, to power shoulder movement. Less commonly, arthroscopic procedures such as debridement may be used in early or mild cases to remove inflamed tissue or loose fragments, but these do not reverse the underlying arthritis. Following surgery, structured rehabilitation is essential to restore movement, strength, and function.
Recovery
When can I return to daily activities
Most people can:
- Return to office or light duties at 10-14 days. Sling should be worn when using a computer / doing admin work
- Light work – 2-3 weeks
- Heavy work – 6 months
- Driving – approximately 4-6 weeks, 15-30 minutes as you feel safe and confident. When you are no longer using the sling and have full control of the vehicle.
- No truck driving until 4 months
When can I participate in leisure activities
Your ability to start these will be dependent on the range of movement and strength that you have in your shoulder following the operation. Please discuss activities in which you may be interested with your physiotherapist or surgeon. Start with short sessions, involving little effort and gradually increase.
General examples are:
- Walking for exercise 2 weeks (continue to wear a sling for 4 weeks in total)
- Exercise bike – 2-4 weeks (Reverse), 4-6 weeks (Total)
- Road bicycle – 6-8 weeks (Reverse), 3 months (Total)
- Gym – 6 months (Reverse), 6-12 months (Total)
- Swimming – Breast stroke – 2 months (Reverse), 3 months (Total), Freestyle (may have to adapt technique) – 4 months (Reverse), 6-12 months (Total)
- Tennis / golf – 4- 6 months