Shoulder Osteoarthritis – symptoms, diagnosis and treatment

Shoulder osteoarthritis is relatively common, especially in people over the age of 65. Rough estimates suggest that shoulder osteoarthritis accounts for between 5-17% of all shoulder pain. Main symptoms include shoulder pain and stiffness. If you experience symptoms of shoulder osteoarthritis you should contact a physical therapist or doctor to get the correct diagnosis and begin treatment.

The two joints in the shoulder

Inside the shoulder are three bones that form two separate joints, the glenohumeral joint and the acromioclavicular (AC) joint. Osteoarthritis is more common in the AC joint, which is located between the collarbone and the tip of the shoulder blade. The glenohumeral joint is located between the humerus (the bone that extends from the shoulder to the elbow) and the scapula (the shoulder blade).

Shoulder osteoarthritis often refers to osteoarthritis of the glenohumeral joint whereas osteoarthritis of the AC joint is specifically known as AC joint osteoarthritis.

Symptoms of shoulder osteoarthritis

Common for shoulder osteoarthritis is that the shoulder hurts and feels stiff. It often becomes difficult to perform daily activities that require lifting your arms, such as getting dressed, showering or brushing your hair.

The most common symptoms of shoulder osteoarthritis include:

• Shoulder pain when lifting your arm
• Shoulder pain at night
• Tenderness
• Stiffness after movement
• Limited range of motion
• Clicking or cracking noises in the shoulder

The type of shoulder pain depends on which joint in the shoulder is affected. When the AC joint is affected, the pain tends to be felt on the top of the shoulder. When the glenohumeral joint is affected, the pain is often felt at the back of the shoulder.

If you experience any of these symptoms you should schedule an appointment with a physical therapist or a doctor.

Several risk factors play a part

There is no single cause for the development of shoulder osteoarthritis. Several risk factors tend to contribute to the development of the joint disease. A main risk factor for glenohumeral joint osteoarthritis is age.  Common risk factors for both glenohumeral joint osteoarthritis and AC joint osteoarthritis include manual labor, previous shoulder injuries, female sex and obesity.

How shoulder osteoarthritis is diagnosed

Shoulder osteoarthritis can sometimes be confused with other shoulder conditions such as subacromial pain syndrome, bursitis, frozen shoulder or rotator cuff disease. Many symptoms of shoulder osteoarthritis are similar to those of other conditions. This is why getting a correct diagnosis is so important for treatment.

Traditionally, osteoarthritis was diagnosed by X-ray. Today, it is still a widespread belief that this method is necessary for diagnosis. However, according to the World Health Organization and extensive international research, osteoarthritis should be diagnosed by a healthcare professional through an assessment based on the patient’s medical history, joint function and pain level.

The healthcare professional will also take risk factors for osteoarthritis into account and keep them in mind when establishing the diagnosis. If you experience pain or stiffness in the shoulder and suspect that you may have osteoarthritis, a good first step is to contact your primary healthcare center and schedule an appointment with a physical therapist or a doctor to receive the right diagnosis.

Occasionally, an MRI examination of the shoulder may be required to rule out other shoulder conditions.

Treating osteoarthritis and shoulder pain

First-line treatment for both shoulder osteoarthritis and many other types of shoulder pain is patient education in combination with individualized shoulder exercises. These individualized exercises should be coordinated by a physical therapist either physically or digitally.

Shoulder exercises should consistently be adapted to the patient’s abilities based on pain and function level. As a complement to first-line treatment, if the pain becomes unbearable, non-prescription painkillers may be used for short periods of time. You should always discuss the use of painkillers with your doctor to avoid side effects and drug interaction. 

Other treatment methods

If first-line treatment isn’t enough to manage your symptoms, other treatments can be offered in addition to the individualized exercises.  On occasion, cortisone injections are used as a complement to treat severe osteoarthritis of the shoulder. These injections only offer short-term symptom relief and should be administered by an experienced orthopedic specialist. Cortisone injections should be used with caution and only when symptoms are not alleviated by the exercises, as excessive injections may further damage the joint. 

In rare cases, surgery may be necessary. Although surgery can provide good results for many patients, an operation is never risk-free. All surgery comes with the risk of developing blood clots and infections. The most commonly performed operation for osteoarthritis of the glenohumeral joint is arthroplasty (joint replacement surgery). For osteoarthritis of the AC joint is distal clavicular excision, which is the removal of part of the collarbone.