Shoulder arthritis: symptoms, causes and treatment options

The NHS lists the main symptoms of osteoarthritis as joint pain and stiffness and problems moving the joint, with some people also having swelling, tenderness and a grating or crackling sound on movement. Severity varies and symptoms may come and go. For the shoulder, the NHS describes pain and stiffness that do not go away over months or years as a pattern that suggests frozen shoulder or arthritis.

Arthritis UK adds that osteoarthritis of the shoulder can be very painful and make moving the arm and shoulder difficult. It might be painful reaching across your body, reaching up above your head or lying on the affected side. Rheumatoid arthritis, an inflammatory type, typically starts in the hands and feet but can affect the shoulders, and Arthritis UK says it is fairly common for people with rheumatoid arthritis to have pain and swelling in their shoulders.

Frozen shoulder is a separate condition in which tissue around the joint becomes inflamed and then tightens. The NHS notes that its pain can be worse at night and that it can take months or years to get better. Because night pain and stiffness occur in both frozen shoulder and arthritis, a clinician decides which applies, sometimes with an X-ray.

Arthritis means inflammation or damage within a joint, and several different conditions are grouped under the term. The two the NHS links to long-standing shoulder pain are osteoarthritis and rheumatoid arthritis. In the shoulder the NHS lists pain and stiffness as the result.

The NHS describes osteoarthritis as the most common type of arthritis in the UK and says almost any joint can be affected, although it most often causes problems in the knees, hips and small joints of the hands. The shoulder is therefore a less frequent site, but it is one the NHS recognises when it lists causes of shoulder pain. The NHS pages used for this guide do not give figures for how common arthritis is in the shoulder specifically, and this page does not invent any.

For osteoarthritis, the NHS lists joint injury, other joint conditions, increasing age, family history, obesity and being a woman as risk factors. Arthritis UK says osteoarthritis is common in the body overall but less so in the shoulder, unless you have had a previous injury or your shoulder joints have been put under extra stress.

Rheumatoid arthritis has a different cause. The NHS describes it as an autoimmune disease in which the immune system attacks the lining of the joints, and Arthritis UK says the inflammation affects the joint lining (the synovium) and may, after a period of time, damage the cartilage, bones and ligaments. The NHS pages used for this guide do not give figures for how common arthritis is in the shoulder specifically, and this page does not invent any.

In osteoarthritis, the NHS says the cartilage that protects the ends of the bones breaks down, and bony growths can develop. Risk factors listed are joint injury, other joint conditions, increasing age, family history, obesity and being a woman. In rheumatoid arthritis the immune system attacks the lining of the joints, causing swelling, stiffness and pain, and over time it can damage joints, cartilage and nearby bone. The NHS says it tends to involve the hands, feet and wrists, can have periods of flare-ups, and may produce tiredness and weight loss.

Arthritis is only one cause of long-lasting shoulder pain. Arthritis UK describes several others that can feel similar, which is why the pattern of pain and movement matters when a clinician makes a diagnosis.

For osteoarthritis, a GP will ask about your symptoms and examine your joints. The NHS says it may be suspected if you are aged 45 or older, the pain gets worse with use and stiffness is absent in the morning or lasts less than 30 minutes. X-rays or blood tests are not usually necessary but may be used to rule out other causes such as rheumatoid arthritis or a fracture. Prolonged morning stiffness is described as a possible sign of rheumatoid arthritis.

Arthritis UK says each shoulder problem has its own pattern of symptoms, and the doctor or physiotherapist will see which movements are most painful. Blood tests are not usually needed for most shoulder problems, but are sometimes used to rule out some types of arthritis. X-rays are good for looking at the bones and minor changes in the joints, though small changes are common and may not be the cause of the trouble. An ultrasound scan can show swelling and tendon or muscle problems, and an MRI scan may be used if a more complex soft-tissue problem is suspected.

If symptoms are more severe, the NHS says you may need painkillers and a structured exercise plan with a physiotherapist. Arthritis UK says treatment for shoulder osteoarthritis depends on the level of pain and how much it has affected range of movement. Physiotherapy can help, you may also need painkillers, and if you have a flare-up where the condition suddenly becomes worse you might need a course of non-steroidal anti-inflammatory drugs (NSAIDs). A steroid injection may be helpful.

Rheumatoid arthritis is treated differently, with long-term medicines to relieve symptoms and slow progression, supported by physiotherapy and occupational therapy. Early diagnosis matters because it reduces the risk of joint damage.

Surgery to repair, strengthen or replace a damaged joint is considered in a small number of osteoarthritis cases where other treatments have not helped or the damage is particularly severe. Arthritis UK says that if non-surgical treatments do not help and the osteoarthritis is really affecting quality of life, you may need to talk to your doctor and physiotherapist about the pros and cons of joint replacement surgery. Questions about the operation, recovery times and risks are best discussed with an orthopaedic surgeon.

The NHS suggests staying active and gently moving the shoulder, trying shoulder exercises, sitting and standing with good posture and using painkillers such as paracetamol or ibuprofen so you can keep moving, with heat or cold packs wrapped in a tea towel. For osteoarthritis generally it recommends regular exercise, losing weight if you are overweight and using devices that reduce strain on joints during daily activities. It advises against stopping using the shoulder entirely.

Arthritis UK suggests a balance of rest and activity, avoiding movements that really hurt, and keeping your elbow bent and at your side if you have to reach up. For pain when lying down it suggests lying on your good side with a pillow supporting the painful arm in front of you. It adds that simple painkillers should not be used for more than two weeks without seeking further medical advice.

Living with a long-term joint condition can mean making adjustments at work and at home. The NHS says it is important to have support to cope with issues such as reduced mobility, and that talking to a GP or to others with osteoarthritis can help.

Ask for a GP appointment if shoulder pain is getting worse, does not improve after 2 weeks or makes the arm very difficult to move. Seek urgent advice from a GP or NHS 111 for sudden or very bad pain, loss of movement, a change in the shape of the shoulder, a hot or badly swollen shoulder, pins and needles that do not go away, pain after an injury, severe pain in both shoulders, or feeling feverish or unwell, as the NHS lists.

Arthritis UK highlights that severe pain in both shoulders, together with pain in the thighs or feeling feverish or unwell, can be a sign of polymyalgia rheumatica, which needs prompt treatment. It also says to tell your GP about unexplained pain lasting more than three weeks, or unexplained weight loss or night-time sweats, because lung conditions can occasionally cause shoulder pain.

On the NHS, shoulder arthritis is usually managed through a GP and physiotherapy, with referral to rheumatology for inflammatory arthritis or to orthopaedics when surgery is being considered. In many areas you can refer yourself to an NHS community musculoskeletal service for physiotherapy. Private orthopaedic and physiotherapy services can be quicker for assessment and scans. The investigations and the stepwise approach are broadly the same, and a clear written summary of what has already been tried makes any referral more efficient.