Shoulder osteoarthritis: symptoms, treatment and shoulder replacement

The shoulder is a ball-and-socket joint, with the rounded top of the upper arm bone fitting into a shallow socket in the shoulder blade, which is why it has such a wide range of movement. Arthritis UK explains that in osteoarthritis the cartilage thins, the joint surfaces roughen and new layers of bone can grow, creating osteophytes that change the joint's shape and make moving the arm difficult.

It is the least frequent of the large-joint sites. Arthritis UK says osteoarthritis is less likely to affect the shoulders than other joints unless you have injured them before, and that injuries and jobs involving repeated strain on the shoulders can raise the risk. It does not always affect both shoulders and may involve only one.

Arthritis UK says the shoulder commonly feels stiff, swollen and painful, and that simple tasks such as shaving or brushing your hair can become surprisingly hard. It describes pain on moving the shoulder, particularly reaching across the body, reaching overhead or lying on the affected side, with the pain often worse at the end of the day or when moving and better after rest. Morning stiffness is usually brief, not more than about half an hour.

• Aching and stiffness that builds slowly over months or years.

• Pain when reaching up or across the body, or when lying on that shoulder.

• Crunching or crackling on movement, which Arthritis UK says usually is not a worry and only sounds loud because the joint is close to the ears.

• Reduced range of movement, making dressing and hair care more awkward.

• Disturbed sleep, which Arthritis UK says osteoarthritis can cause.

Not all stiff, painful shoulders are osteoarthritis. The NHS shoulder pain page offers a guide: pain and stiffness that do not go away over months or years suggest frozen shoulder or arthritis (osteoarthritis or rheumatoid); pain that is worse when using the arm or shoulder suggests tendonitis, bursitis or impingement; a clicking, locking or weak arm with tingling can point to shoulder instability; and sudden very bad pain with difficulty moving the arm may mean a dislocation, fracture or torn tendon. Pain on top of the shoulder can come from the acromioclavicular joint.

The NHS says you should not diagnose yourself, and a health professional will examine you and may arrange tests such as an X-ray. Because osteoarthritis is a clinical diagnosis in NICE guideline NG226 for people aged 45 or over with typical activity-related pain, imaging is not routinely needed unless features are atypical or the diagnosis is in doubt.

Arthritis UK says regular physical activity should be a core part of treatment, with range-of-movement, strengthening and aerobic exercise all useful, and that moving more will not make things worse as many people fear. It suggests starting slowly and building up. A physiotherapist can tailor a programme, and NICE recommends offering tailored therapeutic exercise to everyone with osteoarthritis. The NHS shoulder pain page says physiotherapy is available on the NHS, though waiting times can be long, and that you can pay for it privately.

Practical advice includes avoiding carrying heavy or bulky items with the affected arm, changing position often, taking breaks from sitting to stretch the shoulders and arms, and adjusting a desk chair so the arms and wrists are straight with an L shape at the elbow. For sleep, Arthritis UK suggests avoiding lying on the affected side and lying on your back with a pillow supporting the arm.

Arthritis UK lists paracetamol and, for a flare-up, a short course of NSAIDs such as ibuprofen as options, with the caution that NSAIDs are not suitable for everybody and a pharmacist can advise. NICE says to use medicines alongside exercise at the lowest effective dose for the shortest time and to consider a topical NSAID for joints other than the knee, with an oral NSAID and stomach protection as the next step if needed. It advises against routinely offering paracetamol or weak opioids, glucosamine or strong opioids.

A steroid injection into the shoulder joint can help reduce pain. Arthritis UK says usually only three a year are possible, and NICE says to consider an injection when other treatments are ineffective or unsuitable, explaining that relief is short term, 2 to 10 weeks. Hyaluronic acid injections are not recommended by NICE, and Arthritis UK says they are unlikely to be available on the NHS.

NICE advises against acupuncture and electrotherapy such as TENS for osteoarthritis, although Arthritis UK notes that some people find heat and ice packs helpful, wrapped to protect the skin.

NICE names the shoulder alongside the hip and knee when it advises considering referral for joint replacement where symptoms such as pain, stiffness, reduced function or deformity are substantially affecting quality of life and non-surgical management has been ineffective or unsuitable. The decision should be based on clinical assessment, and age, smoking, other conditions or a high BMI should not by themselves bar referral.

Arthritis UK describes shoulder replacement as well established and very successful, particularly for osteoarthritis and rheumatoid arthritis when severe pain stops the shoulder from moving properly. A newer reverse shoulder replacement, in which the ball and socket are swapped, helps when the rotator cuff tendons have been damaged by arthritis. Physiotherapy after surgery is important, you may not regain full movement or strength, and Arthritis UK says it can take several months to feel the full effects.

The decision involves shared decision-making with a surgeon or advanced physiotherapy practitioner about risks and benefits. Private assessment is available, but the same criteria for suitability apply.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have sudden or very bad shoulder pain, cannot move your arm, your arm or shoulder has changed shape or is badly swollen, you have pins and needles that do not go away or no feeling in the arm or shoulder, the arm or shoulder is hot or cold to touch, the pain followed an injury such as a fall, you have severe pain in both shoulders, or you feel feverish or unwell. The NHS says these can be signs of something serious, such as a broken or dislocated bone or a torn ligament or tendon.

For ordinary persistent pain the NHS says to see a GP if it is getting worse or does not improve after two weeks, or if it is very difficult to move the arm or shoulder. In many areas you can refer yourself to a community musculoskeletal service.