Shoulder
Shoulder Osteoarthritis
Shoulder osteoarthritis is wear of the main shoulder joint, causing deep pain, stiffness and grinding. Mostly over 50s; exercise-based care may help.
Common symptoms
- A deep ache in the shoulder, sometimes spreading into the upper arm
- Stiffness, especially turning the arm outwards or reaching overhead
- Grinding, clicking or crunching when the shoulder moves
- Pain at night, particularly when lying on the affected side
- Difficulty reaching behind your back, brushing your hair or putting on a coat
- Pain after heavy use that settles with rest in the earlier stages
- A gradual loss of shoulder movement over months or years
Overview
The main shoulder joint — the glenohumeral joint — is a ball-and-socket joint where the top of the upper arm bone sits against a shallow socket on the shoulder blade. Both surfaces are covered in smooth cartilage. In osteoarthritis (OA), this cartilage gradually thins and roughens, the bone underneath thickens and small bony spurs can form. The result is a deep ache in the shoulder, stiffness, grinding or crunching with movement, and pain at night.
Shoulder OA is less common than hip or knee OA and mostly affects people over 50, particularly from the sixties onwards. It can appear earlier after a shoulder dislocation, fracture or surgery, and a long-standing large rotator cuff tear can lead to a specific pattern of wear. It is different from frozen shoulder, which also causes stiffness but usually affects people aged 40 to 60 and does not wear the joint, and from arthritis of the small joint at the top of the shoulder (the acromioclavicular joint), which we cover on a separate page.
Shoulder OA is a long-term condition, so care focuses on long-term management. The amount of wear on an X-ray does not always match how much pain someone has, and many people keep a useful, comfortable shoulder for years with the right exercise, activity changes and support during flare-ups. Outcomes vary from person to person.
Causes and risk factors
- Age, with most cases over 50 and especially over 60
- A previous dislocation, fracture or surgery on the shoulder
- A long-standing large rotator cuff tear
- Heavy manual work or many years of overhead, throwing or racket sport
- Inflammatory arthritis such as rheumatoid arthritis
- A family history of osteoarthritis
- Loss of strength in the muscles around the shoulder and shoulder blade
How we may be able to help
Your assessment looks at how the shoulder moves in each direction, which movements reproduce your pain, the strength of the rotator cuff and shoulder blade muscles, and your neck and upper back, which can refer pain into the shoulder. We explain what OA means for you and agree realistic goals, such as reaching a high shelf, sleeping more comfortably or returning to swimming or golf.
Our physiotherapists use gentle joint mobilisation and range-of-movement work to ease stiffness, which many people find reduces pain in the short term, and build a progressive strengthening programme for the rotator cuff and shoulder blade muscles. We also help you adapt daily tasks and pace heavier jobs. Our chiropractor can mobilise the neck, upper back and shoulder where stiffness in these areas is adding to the load on the joint. Interferential therapy may be used as an adjunct for pain during flare-ups.
Where pain has not settled with conservative care, a landmark-guided injection may be considered after assessment. If pain is limiting your daily life or sleep despite good conservative care, an online private GP consultation can be arranged to discuss medication, an X-ray or a referral for a specialist opinion, including whether shoulder surgery might be considered.
What you can do at home
- Keep the shoulder moving every day with gentle pendulum swings and range-of-movement exercises
- Strengthen with light resistance band exercises as shown by your therapist
- Use heat for stiffness before exercise, and ice for 10 to 15 minutes after activities that flare the joint
- Sleep with a pillow supporting the arm and avoid lying on the painful side
- Keep everyday items between waist and shoulder height, and use a step to reach high shelves
- Pace heavier jobs such as gardening, decorating and carrying shopping across the week
Frequently asked questions
Is it frozen shoulder or arthritis?
Both cause stiffness and night pain. Frozen shoulder usually affects people aged 40 to 60, can come on over weeks and does not damage the joint surfaces, while shoulder OA develops gradually, is more common over 60 and often causes grinding. Our assessment helps tell them apart, and an X-ray can confirm OA if needed.
Will exercise wear the joint out faster?
No. Appropriate exercise is a central part of OA care and may help reduce pain and improve function. Strong rotator cuff and shoulder blade muscles help control and support the joint. We tailor the programme so it challenges you without flaring the shoulder.
Do I need an X-ray?
Often the picture is clear from your history and examination, but an X-ray is useful to confirm OA, especially if a specialist opinion is being considered. We can arrange this through an online private GP consultation.
Will I need a shoulder replacement?
Many people with shoulder OA never need surgery. A specialist may consider it when pain and stiffness significantly limit daily life and sleep despite a good trial of exercise and other conservative care. If that point comes, we can help you prepare for and recover from surgery.
This page is general information, not a diagnosis. A clinician will assess you before recommending any treatment. Outcomes vary from person to person. Written with reference to NHS and other peer-reviewed guidance.