Shoulder Joint Osteoarthritis

Osteoarthritis of shoulder joint is a chronic degenerative disease. Osteoarthritis of the shoulder joint is more often seen with Acromio-Clavicular Joint1 than Gleno-Humeral Joint. Osteoarthritis of a shoulder joint is associated with chronic inflammation of articulating cartilage and synovial capsule. Inflammation associated with osteoarthritis causes degeneration of the cartilage, tendon and bones. Degeneration of cartilage results in cartilage fragments and thinning. Bones adjacent to cartilages within the joint shows signs of degenerative joint disease or "Wear-and-Tear" arthritis. Articulating cartilage and adjacent bone wears down as a result of degeneration. Destruction of cartilages removes smooth surface of the linking bones. Fragmented cartilage causes severe pain during shoulder joint movement. Joint space is narrowed because of thinning of cartilages.

 Shoulder Joint Osteoarthritis

Symptoms Of Shoulder Joint Osteoarthritis

1. Pain

  • Mild to severe pain observed during intial stage of the disease and pain become severe during late phase of the disease.
  • Pain becomes progressively severe.
  • Pain is referred to back of scapula or neck.
  • Pain intensity is increased with movements of the joint.
  • Pain is mild at rest and severe with activities.

2. Restricted or Limited Shoulder Joint Movements

  • Patient is unable to lift arm or rotate.
  • Chronic pain results in limited movements of the joint.

3. Shoulder Joint Stiffness

  • Shoulder joint stiffness is observed during movement.
  • Joint stiffness is secondary to inflammation of ligament and muscle spasm.

4. Muscle Spasm

  • Muscle spasm is secondary to chronic severe pain resulting in joint stiffness.
  • Patient often complaints of severe muscle cramps and spasm resulting in severe pain.

5. Clicking or Creaking Noise

  • Movements of shoulder joint cause clicking or creaking noise.
  • Late stage of osteoarthritis cause thinning and fragmentation of articular cartilage.
  • Shoulder joint movement causes friction between uneven fragmented surface of articular cartilage resulting in severe pain and clicking or creaking noise.

Signs of Shoulder Joint Osteoarthritis

1. Muscle Weakness

  • Restricted movements of the shoulder joint secondary to pain results in muscle weakness.
  • Shoulder movement is severely restricted in late stage of shoulder joint osteoarthritis.

2. Muscle Atrophy

  • Osteoarthritis causes severe shoulder joint pain and patients often have restricted joint movement resulting in shoulder muscle atrophy.
  • Loss of muscle mass is secondary to restricted use of muscles because of pain.
  • Shoulder joint muscles in late stage shows signs of atrophy.

3. Tenderness To Touch

  • Pain is elicited when joint is examined.
  • Tenderness is often over the anterior surface of the joint.
  • Examination with hand or finger causes severe pain.

4. Restricted Range of Movements

  • Range of flexion, extension, abduction and rotation are often severely restricted.
  • Patient is often unable to abduct (outward) the arm at shoulder joint.
  • Extent of passive (assisted) and active (self-directed) range of motion is restricted.

5. Crepitus (A Grating Sensation Inside The Joint)

  • Passive or active movement of the joint causes clicking or creaking noise.
  • Passive movement results in grating sensation.

Watch 3D Video on 5 Major Types of Arthritis of the Shoulder Joint

Investigations to Diagnose Shoulder Joint Osteoarthritis

1. X-ray2

X-rays findings are as follows-

  • Narrowing of the joint space
  • Osteophytes or bone spurs are observed on X-Ray.

2. CAT Scan

CAT scan findings suggesting Osteoarthritis of Shoulder Joint are as follows-

  • Narrowing of the joint
  • Osteophytes
  • Thickening of synovial membrane
  • Thinning of articulating cartilages

3. MRI3

MRI scan findings suggesting Osteoarthritis of Shoulder Joint are as follows-

  • Narrowing of the joint
  • Osteophytes
  • Thickening of synovial membrane
  • Thinning of articulating cartilages

4. Ultrasound

Ultrasound will rule out following diseases-

  • Hematoma of the joint
  • Excessive synovial fluid as observed in rheumatoid shoulder joint arthritis.
  • Rule out shoulder joint dislocation
  • Rule out shoulder joint fracture

5. Blood Examination

Erythrocyte Sedimentation Rate (ESR)

  • ESR is increased in Osteoarthritis.
  • ESR blood test is used to monitor the progress of hip joint osteoarthritis and prognosis of the hip joint disease.
  • Erythrocyte sedimentation rate (ESR) is increased during active inflammation. ESR is non-specific test.
  • ESR is also elevated in rheumatoid hip joint disease, septic hip joint disease and psoriatic hip joint arthritis.

Blood Tests to Rule Out Other Causes-

Rheumatoid Factors (RF)-

  • RF is a protein molecule known as antibodies
  • RF may also be present in patients with normal joint and suffering with autoimmune disorders.

Citrulline Modified Proteins (Anti-CCP)-

  • Specific antibodies produced in rheumatoid disease prior to symptoms and during symptoms binds to Citrulline.
  • The test is specific to diagnose rheumatoid arthritis when rheumatoid factor is absent.
  • Anti-CCP predicts severity of Rheumatoid Disease (RD) and also subclinical RD.

ANA Blood Test-

ANA is a non-specific antibody test, which is often positive as in all autoimmune disease.

HLA-B27 Genetic Marker-

Test is positive in inflammatory joint diseases like Psoriatic Hip Joint Disease, Ankylosing Spondylitis and Reiter's syndrome.

Antineutrophil Cytoplasmic Antibodies (ANCA)-

  • ANCA is an abnormal antibodies seen in-patient with history of hip joint pain caused by Wegener's granuloma.
  • Blood examination for ANCA level is performed to rule out Wegener's granuloma as a cause of hip joint pain.

Serum Cytokines-

  • Cytokines and related protein factors are elevated in early stages of rheumatoid disease.
  • Cytokine factors are used as a marker to diagnose early stage of rheumatoid arthritis.

Joint Fluid Analysis (Arthrocentesis)

  • Rule out gout- uric acid crystals are observed in gout,
  • Septic Arthritis- Bacterial cells, red blood cells and pus cells are observed in septic arthritis.

Shoulder Joint Arthroscopy

  • Thin tubular camera is inserted after sedation in shoulder joint through tiny skin incision.
  • Joint structures are observed over television screen.
  • Cartilages, tendon, ligaments and synovial membrane structures are observed for any abnormalities or inflammation.

Treatment for Shoulder Joint Osteoarthritis

1. Conservative Treatment Approach for Shoulder Joint Osteoarthritis


  • Rest is advised during initial phase of osteoarthritis.
  • Inflammation is treated with short-term restriction of joint movement and anti-inflammatory medications.


  • Swimming
  • Yoga Therapy
  • Stretching Exercises Under Supervision

Heat Therapy

  • Moist Heat

Cold Therapy

  • Direct application of ice covered with plastic or cloth over shoulder for 20 to 30 minutes two or three times a day
  • Helps as anti-inflammatory
  • Helps for pain.

Assistive Devices

  • Cane
  • Walker
  • Crutches
  • Wheelchair

Dietary Supplements

Not supported by any research or scientific evidence.

  • Glucosamine
  • Chondroitin Sulfate

2. Physical Therapy (PT) To Treat Osteoarthritis of Shoulder Joint

Objectives of physical therapy (PT) are as follows-

  • Muscle Stretching
  • Muscle Strengthening
  • Prevent Muscle, Ligament and Tendon Atrophy
  • Improve Range of Joint Movement
  • Prevent Joint Stiffness

3. Medication For Shoulder Joint Osteoarthritis

a. Non-Steroidal Anti-Inflammatory Medications (Drugs) - NSAIDs

  • Anti-Inflammatory
  • Non-Opioid Analgesics
  • Side Effects- Stomach Pain, Gastric Ulcer and Bleeding Disorder
  • Most Common NSAIDs Prescribed are Motrin, Naproxen, Daypro and Celebrex

b. Opioids (Narcotics)

  • Analgesics (Anti-Pain Medication)
  • Side Effects- Nausea, Vomiting, Constipation, Dependence and Addiction
  • Most Common Opioids Prescribed are as Follows-
    • Short Acting- Acts for 3 to 4 hours
      1. Hydrocodone, (Vicodine, Lortab and Norco)
      2. Oxycodone (OxyIR)
      3. Morphine (MS IR)
    • Long Acting- Acts for 12 to 24 hours.
      1. Oxycodone (Oxycontin)
      2. Morphine (MS Contin), Avinza
      3. Methadone

c. Muscle Relaxants

Most Common Muscle Relaxants Prescribed Are As Follows-

  • Baclofen
  • Flexeril
  • Skelaxin
  • Robaxin

d. Adjuvant Medications

  • Anti-Epileptic Analgesics- Most common antiepileptic prescribed as analgesics is Neurontin and Lyrica.
  • Anti-Depressant Analgesics- Most common antidepressant prescribed as analgesics is Cymbalta and Elavil.

4. Interventional Treatment For Shoulder Joint Osteoarthritis

Cortisone Injection of Shoulder Joint-

  • Decreases Inflammation.
  • Cortisone Reduces Pain.
  • Most common cortisone injection used for shoulder joint osteoarthritis are DepoMedrol, Kenalog and Decadron.

Nerve Block

Nerve Block Performed For Shoulder Pain Reliefs Are As Follows-

  • Cervical Nerve Block
  • Brachial Plexus Block
  • Field Block of Shoulder Joint
  • Local Anesthetic Medications used for nerve block are lidocaine or bupivacaine.

Reason for Nerve Block-

  • Analgesics to Reduce Pain
  • Assists in Aggressive Physical Therapy
  • Improve Joint Movements

Spinal Cord Stimulator

This is advised when all other treatments fail and chronic intense pain is not responding to oral pain medications including opioids.

5. Surgery

Arthroscopic Surgery-

Arthroscopic Surgery

  • Arthroscope- Tubular camera inserted in shoulder joint following small incision.
  • Surgical Instruments- Surgical instrument is inserted through additional incision in to shoulder joint.
  • Surgical instrument is advanced under camera (arthroscope) guidance.
  • Instrument is directed to diseased section of the joint.
  • Disease and necrotic tissue is removed (debridement) by special equipment while observing through camera.
  • Rotator cuff tear, tendon or ligamental tear is repaired using arthroscopic surgery.

Shoulder Joint Replacement4-

Shoulder Joint Replacement

  • Diseased articulating cartilages covering humerus and glenoid socket is removed with proximal end of humerus.
  • Surgery involves removal of head of humerus and inner surface of glenoid cavity.
  • Proximal end of humerus is replaced with metal or plastic ball.
  • Glenoid cavity cartilages are replaced with plastic or metal prosthesis.

Reverse Replacement-

  • Anatomical position of ball and socket is reversed.
  • The socket is placed over humerus and plastic or metal ball is placed over scapula to replaces glenoid cavity.
  • Surgery helps to prevent deterioration of rotator cuff.
  • Surgery is recommended to prevent symptoms caused by non-functioning rotator cuff.



  • Glenoid cavity, articulating cartilage of glenoid cavity and glenoid socket of scapula is in normal functional shape.
  • Head of humerus and cartilage covering head of humerus is degenerated and deteriorated.
  • Surgery involves replacement of head of humerus with artificial metal or plastic head.

Resection Arthroplasty of AC Joint-

  • Surgical treatment is recommended for painful Acromio-Clavicular Joint (AC Joint) arthritis.
  • Small portion of end of collarbone is removed.
  • The gap is filled with scar tissue in few weeks resulting in elimination of chronic pain.

Complications Following Surgery

  • Bleeding
  • Infection
  • Blood Clots
  • Nerve Injury

Also Read:


1. Osteoarthritis of the acromioclavicular joint.

Clin Orthop Relat Res. 1968 May-Jun;58:69-73.

Worcester JN Jr, Green DP.

2. Osteoarthritis of the glenohumeral joint: a radiologic-pathologic study.

AJR Am J Roentgenol. 1985 May;144(5):967-72.

Kerr R, Resnick D, Pineda C, Haghighi P.

3. Magnetic resonance imaging of glenohumeral joint diseases.

Skeletal Radiol. 1987;16(4):285-90.

Kieft GJ, Sartoris DJ, Bloem JL, Hajek PC, Baker LL, Resnick D, Obermann WR, Rozing P, Doornbos J.

4. Shoulder arthroplasty in osteoarthritis: current concepts in biomechanics and surgical technique.

Transl Med UniSa. 2013 May 6;6:16-28.

Merolla G, Nastrucci G, Porcellini G.

5. Long-term follow-up of shoulder hemiarthroplasty for glenohumeral osteoarthritis.

J Bone Joint Surg Am. 2012 Nov 21;94(22):e164. doi: 10.2106/JBJS.K.00603.

Levine WN, Fischer CR, Nguyen D, Flatow EL, Ahmad CS, Bigliani LU.

Written, Edited or Reviewed By:


Last Modified On: September 6, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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