ConditionBones, joints & muscles
Shoulder Arthritis
Shoulder arthritis is wear or inflammation of the shoulder joints that damages the smooth cartilage covering the bones. It causes a deep ache in the shoulder, pain at night, stiffness and a grinding feeling when you move your arm. The most common type is osteoarthritis of the main ball-and-socket joint (glenohumeral joint) or of the AC joint at the top of the shoulder. Others include rheumatoid arthritis, arthritis after a large rotator cuff tear, and arthritis after injury. Exercises, pain relief and injections help, and shoulder replacement works well for advanced cases.
Also called: Arthritis of the shoulder, glenohumeral arthritis, shoulder osteoarthritis, AC joint arthritis, rotator cuff tear arthropathy
At a glance
- What it is
- Loss of joint cartilage in the shoulder, leading to pain and stiffness.
- Main types
- Glenohumeral osteoarthritis, AC joint arthritis, rheumatoid arthritis, rotator cuff tear arthropathy, post-traumatic arthritis.
- Key symptoms
- Deep ache, night pain, stiffness in all directions, grinding, weakness.
- Diagnosis
- Examination and X-rays; MRI or CT before surgery.
- Treatment
- Activity changes, physical therapy, pain relief, steroid injections; anatomic or reverse shoulder replacement.
When to get help
Call 911 or go to the ER
- Shoulder or arm pain with chest pressure, breathlessness, sweating or nausea, especially on the left (possible heart attack): call 911 or your local emergency number
- A hot, red, swollen shoulder with fever, particularly after an injection or with a shoulder replacement (possible joint infection)
See a doctor within a day or two
- Sudden severe shoulder pain and loss of movement after a fall (possible fracture or dislocation)
- Sudden inability to lift the arm after a lift or pull (possible acute rotator cuff tear)
- Fever, wound drainage or new pain in a replaced shoulder
Book a routine appointment
- Shoulder pain that wakes you at night or limits dressing and reaching for more than a few weeks
- Grinding, clicking and stiffness that are slowly getting worse
- Swelling and stiffness in several joints, including both shoulders, with morning stiffness over 30 minutes
Usually safe to manage at home
- Mild aching after unusual activity in a known arthritic shoulder: rest from aggravating tasks, heat or ice, gentle range-of-motion exercises and over-the-counter pain relief for a few days
The shoulder joints
The shoulder has two joints that commonly develop arthritis:
- Glenohumeral joint: the main ball-and-socket joint, where the ball at the top of the arm bone (humerus) sits in a shallow socket (glenoid) on the shoulder blade.
- Acromioclavicular (AC) joint: a small joint at the top of the shoulder where the collarbone meets the tip of the shoulder blade.
In arthritis, the smooth cartilage on these joint surfaces wears down or is damaged by inflammation. Bone rubs on bone, bony spurs form, and the joint lining becomes inflamed.
Types of shoulder arthritis
| Type | Who gets it | Features |
|---|---|---|
| Glenohumeral osteoarthritis | Usually over 50 | Deep pain, stiffness, grinding; X-ray shows narrowed joint and spurs |
| AC joint arthritis | Middle-aged adults, weightlifters, manual workers | Pain on top of the shoulder, worse reaching across the body or overhead |
| Rheumatoid arthritis and other inflammatory types | Any age | Both shoulders, other joints involved, morning stiffness |
| Rotator cuff tear arthropathy | Older adults with a long-standing large rotator cuff tear | Ball rides up out of socket; weakness lifting the arm |
| Post-traumatic arthritis | After fractures or dislocations | Can appear years after injury, sometimes in younger people |
| Avascular necrosis | Steroid use, alcohol, sickle cell disease | Bone of the ball loses blood supply and collapses |
Symptoms
- a deep ache inside the shoulder, often felt at the back for glenohumeral arthritis or on top for AC joint arthritis
- pain that worsens with activity and gradually becomes present at rest
- night pain, especially lying on the affected side
- stiffness and loss of movement, making it hard to reach behind your back, comb your hair or reach high shelves
- grinding, clicking or crunching (crepitus)
- weakness, especially with cuff tear arthropathy
Symptoms usually progress slowly over years, with flares after overuse.
Shoulder arthritis vs frozen shoulder vs rotator cuff problems
| Shoulder arthritis | Frozen shoulder | Rotator cuff problems | |
|---|---|---|---|
| Age | Usually 60+ | 40 to 60, diabetes common | 40+ |
| Onset | Gradual over years | Over weeks; painful phase then stiff phase | Gradual or after injury |
| Movement | Stiff in all directions, with grinding | Very stiff, especially turning arm outward; no grinding | Painful arc lifting arm; often full passive movement |
| X-ray | Joint narrowing, spurs | Normal | Usually normal (until late) |
| Course | Slowly progressive | Usually resolves over 1 to 3 years | Variable |
How it is diagnosed
- History: where the pain is, what makes it worse, previous injuries or surgery, other joint problems.
- Examination: range of movement (both active and with the examiner moving the arm), strength of the rotator cuff, tenderness over the AC joint, and crepitus.
- X-rays: confirm arthritis, show joint space narrowing, bone spurs, and the position of the ball in the socket.
- CT scan: maps bone loss in the socket before replacement surgery.
- MRI or ultrasound: assesses the rotator cuff, which determines the type of replacement.
- Blood tests: if inflammatory arthritis is suspected.
- Diagnostic injection: numbing medicine into the AC joint can confirm it as the pain source.
Treatment
Non-surgical treatment
- Activity changes: avoid repeated overhead lifting, heavy pushing and sleeping on the painful side; adapt tasks rather than stopping all use.
- Physical therapy: gentle stretches to maintain motion (pendulum swings, wall walks, cross-body stretches within comfort) and strengthening of the rotator cuff and shoulder blade muscles.
- Pain relief: topical or oral NSAIDs, or acetaminophen (paracetamol). Follow the label dose; NSAIDs can cause stomach and kidney problems.
- Heat or ice: 15 to 20 minutes for flares.
- Corticosteroid injections: into the glenohumeral or AC joint can relieve pain for weeks to months; repeated injections are limited.
- Disease-modifying medicines for rheumatoid and other inflammatory arthritis.
Hyaluronic acid and platelet-rich plasma injections have limited and mixed evidence for shoulder arthritis.
Surgery
- Arthroscopic debridement: cleaning out loose fragments; offers temporary relief for selected younger people.
- Distal clavicle excision: removing the end of the collarbone for persistent AC joint arthritis; usually done through keyhole surgery.
- Anatomic total shoulder replacement: replaces the ball and socket with metal and plastic parts that mimic normal anatomy. Requires a working rotator cuff. It reliably relieves pain and improves motion.
- Reverse total shoulder replacement: swaps the ball and socket positions so the deltoid muscle can lift the arm. Used for cuff tear arthropathy, failed previous surgery and some fractures.
- Hemiarthroplasty: replaces only the ball; now used less often.
Recovery after shoulder replacement
Expect a sling for about 4 to 6 weeks, physical therapy for several months, no driving for around 6 weeks, and most of the improvement within 6 months, with continued gains up to a year. Over 90% of modern shoulder replacements are still working 10 years later.
Living with shoulder arthritis
- Keep the shoulder moving every day with gentle exercises; complete rest leads to more stiffness.
- Sleep with a pillow under the affected arm or in a recliner during flares.
- Use long-handled tools and keep everyday items between waist and shoulder height.
- Stay active with walking, cycling or swimming strokes that do not hurt.
Frequently asked questions
What are the symptoms of arthritis in the shoulder?
Common symptoms are a deep ache in the shoulder, pain at night, stiffness in all directions, grinding or clicking, and difficulty reaching overhead or behind the back. AC joint arthritis causes pain on top of the shoulder, especially when reaching across the body.
What is the best treatment for shoulder arthritis?
Most people start with physical therapy, activity changes and pain relief such as NSAIDs. Steroid injections help flares. When pain and stiffness seriously limit daily life despite these, shoulder replacement offers reliable, long-lasting pain relief.
What exercises help shoulder arthritis?
Gentle range-of-motion exercises such as pendulum swings, wall walks with the fingers, and cross-body stretches help maintain movement. Light strengthening of the rotator cuff with a resistance band supports the joint. A physical therapist can tailor a program to your shoulder.
What is a reverse shoulder replacement?
In a reverse shoulder replacement, the ball is placed on the shoulder blade and the socket on the arm bone. This lets the deltoid muscle lift the arm when the rotator cuff is torn or not working. It is the usual operation for arthritis with a large rotator cuff tear.
Can shoulder arthritis be reversed?
No. Damaged cartilage does not grow back. However, exercise, weight management, pain relief and injections can reduce pain and keep the shoulder working for years, and joint replacement can restore comfortable movement when arthritis is advanced.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Orthopaedic Surgeons (OrthoInfo): Arthritis of the shoulder; Shoulder joint replacement
- American Academy of Orthopaedic Surgeons: Clinical practice guideline on management of glenohumeral joint osteoarthritis
- NHS: Shoulder pain
- Arthritis Foundation: Shoulder arthritis
- Versus Arthritis: Shoulder pain