Shoulder osteoarthritis, or glenohumeral osteoarthritis, cannot be cured. Worn cartilage does not grow back. But it is treated very well, and the great majority of patients go for years without surgery thanks to physiotherapy, painkillers and sometimes injections. When those treatments are no longer enough, shoulder replacement takes over and the pain disappears.
This page sets out what each treatment can genuinely offer, in the order in which we propose them, and at what point the question of an operation really arises.
Osteoarthritis is the wearing away of the cartilage covering the head of the humerus and the glenoid, the facing surface of the shoulder blade. This wear is slow, gradual and permanent.
No treatment, medicine, food supplement or injection rebuilds cartilage. Be wary of any promise of that kind. What we treat are the consequences: pain, stiffness and loss of function.
That is good news more than bad, because these three consequences respond well to treatment, even as the X-ray continues to deteriorate.
This is the mainstay of treatment, and it is the one most often neglected, by patients and by doctors alike.
An osteoarthritic shoulder that keeps moving hurts less than an osteoarthritic shoulder that stiffens up. The physiotherapist's work aims to maintain range of movement, the rotations in particular, and to strengthen the muscles around the joint so that they take on part of the load.
The benefit is not immediate. It is measured over several months, and it fades if you stop. It is upkeep, not a cure.
Paracetamol remains the first-line treatment, taken regularly rather than on demand when the pain is there every day.
Anti-inflammatories are effective on painful flare-ups, but they are taken in short courses and under medical supervision, because of their effects on the stomach, the kidneys and blood pressure. They are not a long-term treatment for osteoarthritis.
It acts on the inflammation that comes with flare-ups. The relief is often clear and rapid, but it is temporary, from a few weeks to a few months depending on the patient.
Its real value does not lie in being repeated indefinitely. It lies in opening a pain-free window during which rehabilitation can at last be done properly. An injection with no physiotherapy behind it is a missed opportunity.
We do not repeat them freely: repeated corticosteroid injections weaken the tendons, and they call for a delay before any surgery because of the risk of infection.
Viscosupplementation means injecting a gel intended to improve lubrication of the joint. Results are inconsistent in shoulder osteoarthritis and the level of evidence is weaker than for the knee. It is a reasonable option in some patients, not a standard of care.
Platelet-rich plasma injections are offered in certain tendon conditions. In established shoulder osteoarthritis, they do not rebuild cartilage and their benefit remains debated. They are not reimbursed.
Keep using your arm. A shoulder you spare will stiffen up, and a stiff shoulder hurts more than a worn but mobile one. This is the most useful piece of advice on this page.
Adapt rather than give up: bring everyday objects closer to you, avoid repeated overhead movements and carrying heavy loads with the arm outstretched, but keep up walking, cycling and swimming if it does not wake you at night.
Heat before exercise loosens things up, cold afterwards calms them down. And do the few exercises your physiotherapist has shown you every day, even on the days when you are not in pain.
The decision is never taken on the X-ray. A shoulder with severe osteoarthritis but little pain is not operated on.
What prompts the decision is the real impact on your life: pain that has become daily, that wakes you at night, that gets in the way of dressing or washing, and that persists despite well-conducted physiotherapy and medical treatment properly taken.
The standard surgical treatment is shoulder replacement. If the rotator cuff is intact, it is the anatomic shoulder replacement, which gives back the best range of movement. If the cuff is torn and cannot be repaired, it is the reverse shoulder replacement.
Waiting is not dangerous. Shoulder osteoarthritis left unoperated does not put your arm at risk, and nothing obliges you to decide quickly.
But waiting has a price, and it is better to know it. The wear gradually hollows out and deforms the glenoid, which makes fitting the implant more difficult and worsens the result. A rotator cuff that tears in the meantime shifts the plan from an anatomic shoulder replacement to a reverse shoulder replacement, which performs less well in rotation. And a shoulder that has been painful for years stiffens up, which lengthens rehabilitation accordingly.
The question of age is covered in detail on the shoulder replacement: at what age page.
The first result, and by far the most important one for patients, is that the osteoarthritic pain disappears. It is obtained from the operation itself, before rehabilitation has even begun.
Because I do not detach the muscles during the operation, there is no sling and no immobilisation afterwards, and driving can be resumed straight away. Rehabilitation lasts three to four months, at three sessions a week. The details are on the after a shoulder replacement page.
No. Worn cartilage does not grow back, and no medicine, supplement or injection rebuilds it. On the other hand its consequences, pain and stiffness, are treated very well, and shoulder replacement makes the pain disappear when other treatments are no longer enough.
There is no single one. We start with physiotherapy and painkillers, we add an injection if pain is preventing rehabilitation, and we reserve shoulder replacement for shoulders that remain painful despite well-conducted treatment.
A corticosteroid injection often brings clear relief, but for a few weeks to a few months. Its real value is to open a pain-free window in which physiotherapy can be done. We do not repeat them indefinitely, because they weaken the tendons and call for a delay before any surgery.
Results are inconsistent and the level of evidence is weaker than for the knee. It is a reasonable option in some patients, but it is not a standard treatment for shoulder osteoarthritis.
Yes, it is the mainstay of treatment. An osteoarthritic shoulder that keeps moving hurts less than an osteoarthritic shoulder that stiffens up. The benefit is measured over several months and it fades if you stop: it is upkeep, not a cure.
When the pain has become daily, when it wakes you at night, when it gets in the way of dressing or washing, and when it persists despite physiotherapy and medical treatment. Never on the X-ray alone.
Nothing dangerous, but the wear deforms the glenoid, which makes fitting the implant more difficult, a rotator cuff that tears later can shift the plan to a reverse shoulder replacement, and the shoulder stiffens up, which lengthens rehabilitation.
Yes, with adjustments. Walking, cycling and swimming remain recommended. Avoid repeated overhead movements and carrying heavy loads with the arm outstretched. Being inactive is more harmful than suitably adapted activity.
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