Osteoarthritis of the Shoulder

Physiotherapist performing scapula exam on patient with shoulder pain.

There are lots of different types of arthritis that can affect people. The following information will focus on osteoarthritis, which is the most common type of arthritis.

What is osteoarthritis of the shoulder?

Osteoarthritis in general is often misunderstood and as a result there are a lot of mistruths and myths about it.

In simple terms, it is best to consider osteoarthritis as the aging process of your joints. If you look in the mirror, you may find that you do not look like you did when you were 18 years old. You may have a few more wrinkles and a few more grey hairs than back then and these are generally accepted by most people as the outward signs of aging. Your joints undergo the same aging process and as a result you are exactly the same age on the inside as you are on the outside. Therefore, it isn’t realistic to expect your joints to look like they did when you were 18 either. Perhaps thinking about osteoarthritis as the normal grey hair and wrinkles of your shoulder joint may help you understand it better.

Why have I heard it described as ‘wear and tear’ then?

As with many other things, sometimes when certain words or phrases are used to describe something, they stick. Unfortunately, the term ‘wear and tear’ is used very regularly to describe osteoarthritis and it is not very helpful. Nothing in your shoulder is ‘worn’ or ‘torn’, therefore the phrase can be misleading as it suggests that osteoarthritis is damage to the shoulder.

Does it really matter what you call it?

We really think it does. Words are incredibly important as they help us understand what might be going on in our shoulder and what we are dealing with. If you have been told that you have osteoarthritis and that it's something you need to be concerned about, then it is only human to find yourself worrying about it. If things are explained correctly and words, phrases and images are used appropriately, you are likely to understand the issue better and be in a better frame of mind to do something about it. It is important to know this as what you think and how you feel about your shoulder can influence the chances of you getting better from it or not (Chester et al, 2018).

We have intentionally written this information to give you the right advice and guidance to see your way through to a better place with your shoulder

Scrabble letters spelling out 'Words have power'.

So, my shoulder isn’t damaged?

Osteoarthritis isn’t damage and therefore, using the word ‘damage’ to describe it is not accurate. Osteoarthritis describes the adaptive and useful changes in the way your joint looks and works in order for it to cope with the fact that it is getting older (not 18 years old anymore!).

What are the common symptoms with osteoarthritis of the shoulder?

This is a really important question and it is useful for you to know what is normal for a shoulder that may have osteoarthritis. We’ve broken the answer down into things that are found most commonly:

Osteoarthritis can cause pain but equally so, sometimes doesn’t cause any pain at all. In most cases, shoulder pain is felt within the shoulder itself. However, for a number of people the pain can be mostly felt further down into their arm. If your pain is mostly in your upper arm and not necessarily in the shoulder, it is still right to call it shoulder pain as it is most likely that the pain is travelling down from the shoulder to that area. This is called referred pain. In some cases, it is possible for shoulder pain to travel all the way down to the hand.

In most cases of shoulder osteoarthritis, the shoulder will feel stiff. It is often reported that stiffness is most common first thing in the morning and after any period of resting. Usually the worst of the stiffness doesn’t last longer than 30 minutes, but overall, the movement of the shoulder itself may be limited.

With some of the symptoms that are seen most commonly with osteoarthritis of the shoulder i.e. pain and stiffness, it can sometimes be difficult to use the shoulder properly. Lifting the arm, reaching or doing simple things like getting dressed can be quite a challenge for some.

Clicks, pops, clunks and grinds are very normal in all joints and in the vast majority of cases are nothing to worry about. Noises or a creaking coming from your shoulder is very common with osteoarthritis of the shoulder. With noise, people often find themselves worrying that they are ‘wearing the shoulder out’ because of the noises it makes. This is simply not the case and your shoulders, along with all of your joints, are strong, robust and designed to last you a lifetime. Noises are often gas bubbles popping in the joint or friction between the moving surfaces. Noises from an osteoarthritic shoulder are normal and not to be worried about.

How is osteoarthritis diagnosed?

In most cases, osteoarthritis can be suspected or diagnosed through the clinical features (what it looks like and how it behaves), your symptoms (what you tell us about your shoulder) and the clinical assessment (testing the movements etc.). An X-ray of the shoulder is often used to help diagnose osteoarthritis but is not always required.

Why are X-rays/scans not always required?

In a lot of cases, the information we as healthcare professionals can get from asking you questions and testing the shoulder is enough to make a decision. X-rays are a very useful tool as they show you what your shoulder looks like on the inside. However, in some cases what your shoulder looks like on the inside doesn’t really marry up with what your problem might be.

There is growing evidence (experiments and clinical studies) that demonstrate what you see is not always what you get with X-rays and scans and that a lot of the so-called ‘worn out’ or ‘abnormal’ findings are seen commonly in people with no pain, stiffness or symptoms.

Interestingly, in a clinical study (a type of experiment) Gonçalves Barreto et al. (2019) MRI scanned both shoulders of over 100 people who had shoulder pain in only one arm (in other words, they had both the ‘good’ arm and ‘bad’ arm scanned). They found almost exactly the same amount of ‘abnormalities’ on both the ‘good’ and ‘bad’ sides. To simplify, they found things like osteoarthritis of the shoulder on both sides even though only one side hurt. This means that just because you can ‘see’ something on a scan, it doesn’t always mean that it is an actual problem or the source of your symptoms.

What causes osteoarthritis of the shoulder?

This is a difficult question and the simplest answer is that it is complicated. As we’ve explained in the last question, what you see is not always what you get and just because an X-ray/scan says you’ve got osteoarthritis of the shoulder, doesn’t mean you’ll actually have any problems.

There are many factors that will influence the development of osteoarthritis, including increased weight, low activity levels, previous injury, diet, genetics and negative beliefs. It is unlikely that just one of these factors will cause osteoarthritis, however, they may influence whether a person experiences symptoms or not.

What can I do to help myself?

Reassuringly, there are a number of things that you can do to help get your shoulder going and start your rehabilitation.

Taking time to read and digest the information above will hopefully help you understand that osteoarthritis isn’t something that should be feared, that it’s safe to be sore and that you can do something about it. Understanding the problem is halfway to dealing with it.

Exercise, including strengthening exercise (working against something like a weight, gravity or exercise bands) is considered one of the key treatments for osteoarthritis.

Exercise comes in many shapes and forms and there is no ‘best’ exercise. Often it is best to think of the most effective exercise as the one you enjoy and will actually do. Current recommendations on exercise and how often we should be looking to do it can be found here: Understanding Exercise

We have included a series of exercises at the bottom of the page that will be able to help you move forwards with managing your shoulder complaint.

Some people will choose to manage their pain with pain relief, whilst some may choose to avoid medication. Applying something cold to your shoulder may also be useful in helping with some of the pain (do remember to wrap your frozen peas in a towel before applying them to your skin to avoid cold burns).

Weight loss is recommended as something that is important for the management of most muscle and bone issues. Losing weight is difficult and we understand that.

Often people will think that simply putting more weight through their joints is the reason why they get problems and that being closer to their ideal body weight will simply stop their symptoms. Unfortunately, it isn’t that easy. It is worth knowing that fat cells are very active cells and one thing they do is produce chemicals that can affect pain sensitivity (Tashani et al, 2017).

By looking at diet, exercise, sensible goal setting and establishing a good support network, a weight loss journey is more likely to succeed and the benefits to your shoulder are more likely to be influenced by the journey you take to lose weight, rather than being lighter.

If you would like some support to help you with your weight loss journey, please contact our partners at Feel Good Suffolk or Active Norfolk.

What can physiotherapy do for me?

Physiotherapy for shoulder complaints including osteoarthritis can be effective. We offer a range of options to help you manage your complaint with our rehabilitation classes forming the main part of what we can offer you.

Find out about our classes here: Classes

Is there anything I should look out for?

In most cases, shoulder symptoms associated with osteoarthritis are easily recognised, but occasionally there are things that do not fit and should be highlighted to either your doctor, nurse or physio.

Generally feeling unwell and/or a temperature alongside your shoulder pain

Considerably swollen and hot shoulder

If your shoulder issues have been since an injury such as a fall

High levels of pain/inability to sleep due to your pain levels

If you have your shoulder issues and have a history of cancer

If you have your shoulder issues and you have a history of osteoporosis or have taken steroids for a long time

Will it get better?

In a lot of cases, it is possible for you to improve the symptoms you have with your shoulder. Obviously, you cannot turn back the clock and the osteoarthritis will still be there even if you feel better, but by being stronger, fitter, more confident and closer to your ideal bodyweight, you can start to regain some more control over your shoulder.

What would a good outcome look like?

This is obviously very variable between people. For most, being able to regain all of the movement back in your shoulder (i.e. to get rid of all the stiffness) is often very difficult and does not tend to happen. However, you may find that rehabilitation can help control the symptoms of discomfort and help you to be able to use your shoulder more normally.

How long will it take before I feel something?

This is a very difficult question but it is best think about how much time and effort you are going to throw at the challenge and how confident and motivated you are to do something about it. If you work hard and are consistent with what you do, often people will notice signs of a positive response within weeks to months. If you are not committed to the challenge it will take longer or may not respond at all.

Frequently asked questions

Below are some of the common questions that are asked when talking about shoulder issues that haven’t been covered in the information above.

Q: I don’t have any weights at home, how am I supposed to do the exercises?

A: This doesn’t matter. Most, if not all, of the exercises below can be modified or adapted using heavy bags, bottles of water or even books.

Q: It hurts when I move my shoulder, are you sure I should be doing exercise?

A: Yes. As mentioned above, exercise is the best medicine for most things, including sore shoulders. Think of your shoulder as being strong and robust but irritated. It might be that starting exercise might cause a bit of irritation, but it will not damage your shoulder; it is safe to be sore.

Q; How many exercises should I be doing?

A: Good question. For strengthening, it doesn’t matter too much as long as you work until your muscles can’t give you any more. In other words, you exercise until your muscles start to tire. It is worth noting your muscles will get sore as they tire, but this is ok and it often means you are pushing things as hard as you should.

Have a look at our exercise tips to help you get the best out of your chosen exercise/s.

Q: Shouldn’t I rest a painful shoulder?

A: Rest is not evil and can be very useful if you’ve ‘overdone’ it, but rest doesn’t change you for the better and rest will not change your shoulder for the better.

Q: What happens if I do all this and it just doesn’t get better?

A: Firstly, ask yourself if you have really done everything you can to try and move your shoulder issue forwards. If the answer is no, consider re-reading the information above and seeking some guidance from your physio.

If you really have worked hard at the above advice and guidance, then some people do find benefit from steroid injections into the shoulder joint, but it is worthwhile remembering, steroids are drugs and there is always the possibility of side-effects and it not working. Injections should not be used to manage your shoulder pain long-term, as they are often only associated with short-term benefits (Gross et al, 2013). You can discuss this option with your GP.

If you still don’t find any benefit from your injection, then you may be referred to the hospital to have a discussion with the Bone and Joint teams about your options.

Exercise tips:

For the movement exercises, aim to try and complete these little and often throughout the day. Only move as far as you feel comfortable to move.

For the strengthening exercises, aim to complete the exercises (as many or as few as you want to) about 3 to 4 times a week.

Each exercise should be completed between 8-12 times (or repetitions) for 3 to 4 sets. Make sure you have about 1 minute's rest in between each set.

In order to change your muscles, you need to challenge them. In other words, you should really feel the effort with each set of exercises and should really not be able to do more than 12 each time around.

Movement Exercises

Strengthening Exercises

Standing Exercises

Sitting/Lying Exercises:

Need more help? Refer yourself here.

References:

Chester, R., Jerosch-Herold, C., Lewis, J and Shepstone, L. (2018). Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study. British Journal of Sports Medicine. 52 (4) http://dx.doi.org/10.1136/bjsports-2016-096084. Accessed 05/05/2021.

Goncalves Barreto, R., Braman, J.P., Ludewig, P.M., Pechincha, R and Rezende Camargo, P. (2019). Bilateral magnetic resonance imaging findings in individuals with unilateral shoulder pain. Journal of Shoulder and Elbow Surgery. 28(9):1699-1706. doi: 10.1016/j.jse.2019.04.001. Accessed 10/06/2021

Gross C, Dhawan A, Harwood D, Gochanour E and Romeo A. Glenohumeral joint injections: a review. Sports Health 2013; 5: 153–9.

Bricca A, Roos EM, Juhl CB, Skou ST, Silva DO, Christian J & Barton CJ. (2019) Infographic. Therapeutic exercise relieves pain and does not harm knee cartilage nor trigger inflammation. BJSM. DOI: 10.1136/bjsports-2019-100727