Do You Have Shoulder Osteoarthritis? What You Can Do About It

Suffering from shoulder osteoarthritis—or any osteoarthritis, for that matter—is one of the worst types of suffering. 

It’s all fun and games while you’re lying on your back, reading a book. However, once you get up and reach for your raincoat, that’s when the pain hits you. The condition lets you forget you have it while inactive—however, it locks your body down the second you need it.

Due to the degenerative nature of the disease, it’s not going to go away on its own. And, when you start looking at treatment options, you’re faced with difficult tradeoffs: take away the pain with effective yet detrimental steroid injections, clench your teeth through months of physical-therapy-slash-medication-combo, or risk surgical complications and a life of revision surgeries.

Today, there’s a new option—an option that could potentially solve arthritis for good.

What Is Shoulder Osteoarthritis?

Ever accidentally grind your teeth in a way that makes you want to shake the feeling off? Well, that’s exactly what would happen in places where joints connect in our body—knees, wrists, elbows, hips, spine, shoulders—if not for a thin protective film, called articular cartilage, that enables our joints to connect without friction.

Osteoarthritis—also known as degenerative joint disease—is a condition that describes the deteriorating articular cartilage. 

For shoulder osteoarthritis, the term specifically isolates the cartilage between the two major joints that make up the shoulder—the acromioclavicular joint, where the highest point of the scapula (acromion) meets the clavicle, and the glenohumeral joint.

As the cartilage does not have any nerve cells, the deterioration of the protective film does not cause pain on its own. However, mobility and pain problems occur once the cartilage deteriorates to a point where there is bone-to-bone friction between the joints.

Osteoarthritis as a whole is a huge burden to the patients and, in turn, to society. According to the OAA study in 2014, osteoarthritis cost on average $80 billion in lost earnings per year between 2008 and 2011.

Osteoarthritis is the most prevalent and expensive disease, costing more than $200 billion every year and affecting more than 100 million people. A review from 2011 found that “the costs due to absenteeism from osteoarthritis alone are at least $11.6 billion due to an estimated three lost workdays per year.” 

According to the American Academy of Orthopaedic Surgeons, “osteoarthritis accounts for more than 25 percent of all arthritis-related health care visits.”

Is Osteoarthritis Dangerous?

While it’s not as dangerous as knee osteoarthritis—which is the leading cause of disability in the US—damage to the articular cartilage in the shoulder can become a central health issue, affecting nearly all areas of your life:

• Regular day-to-day activities and movement: Up to 80% of osteoarthritis patients report that some of their movements are limited, while around 25% of OA patients say that they can’t perform any major activities in their life. This means that your life can change to a point where you’ll have difficulty picking up the shopping bag, opening the car door, or filling a kettle with water.
• Sleep: Sleep is one of the most important areas of our lives, and when the quality of sleep goes down, the quality of life soon follows. Unfortunately, shoulder osteoarthritis can brutally cut into your hours of rest. Joint pain can wake you up at night, while stiffness and a limited range of motion will make it hard to get comfortable in bed.
• Work and house chores: Even if your work mostly revolves around the desk, you may find it difficult to find a comfortable position while sitting behind a computer. Your shoulder may hurt every time you reach for your phone. Such distractions at work are very irritating since you’re already putting your “power of will” to focus on the task at hand.
• Weight gain and health: Your exercise plan and outdoor activities are the first ones to take a major hit as your osteoarthritis progresses. This quickly turns into a fully sedentary lifestyle, weight problems, and subsequent health issues—both physical and mental. 

But that’s just day-to-day stuff. Shoulder osteoarthritis can lead to severe complications, including:

• Bone death (osteonecrosis): Osteonecrosis occurs when the bone dies because it does not get enough oxygen and blood. While the primary cause of bone death is thought to be trauma (such as dislocation), cartilage deterioration can also contribute to the problem.
• Stress fractures: Articular cartilage, besides removing bone-to-bone friction, also serves as a soft cushion that absorbs shock between the two joints. When the cartilage is worn down, it becomes thin, and the probability of a stress fracture increases.
• Bleeding or infection in your joint: OA can cause bleeding and infection in the joints, which can make osteoarthritis worse, or even cause additional complications.
• Deterioration of tendons and ligaments around the joints: Much like with stress fractures, articular cartilage provides stability and shock protection to the surrounding tissues, involving bones, ligaments, and joints.

What Causes Shoulder Osteoarthritis?

The degeneration of the protective cartilage is an unavoidable, gradual process. Many key factors influence how quickly your shoulder articular cartilage will deteriorate:

• Heavy, repetitive activity: Compared to the knees and the hips, shoulders are relatively unlikely to develop osteoarthritis. The reason is simple: our knees and hips receive a much heavier workload throughout life—especially if you’re off your BMI charts. Shoulders, however, are just as prone to injury—especially if your day-to-day life involves lifting heavy objects (construction, free weights) or throwing (baseball, football.)
• Trauma: Shoulder trauma is a primary cause of damage to the cartilage. A broken bone, dislocation (when the humeral head pops out of its socket), or other serious injury or surgery can cause damage to the shoulder joint that eventually leads to shoulder osteoarthritis. The symptoms may not surface for years after the trauma, making diagnosis elusive.
• Age: Age is a key factor in developing osteoarthritis, most often occurring in people over the age of 50. In the US, shoulder osteoarthritis is prominent in “up to 32.8% of patients over the age of 60.”
• Genetics: Some people simply are more prone to injury due to their bone alignment. Poor bone alignment can cause bone dislocations and increase natural cartilage degeneration. It is also shown that people whose family members have osteoarthritis are more likely to develop the condition.
• Gender: It has been clinically shown that women are more likely to develop osteoarthritis.

What Are the Symptoms of Shoulder Osteoarthritis?

As osteoarthritis defines the deterioration of the articular cartilage in between the shoulder joints, the symptoms of the condition revolve around pain, limited mobility, and cracking (popping) sounds:

• Shoulder pain: As it’s a joint issue, the pain may subside while you’re idle, and erupt suddenly as you move your arms and shoulders. Depending on which of the two shoulder joints is affected, you may feel a deep ache on the backside of your shoulder, or you may feel top-of-the-shoulder pain that spreads towards the neck.
• Limited motion: A restricted range of motion is a strong indication of shoulder osteoarthritis. If you suddenly notice that you have a hard time performing usual day-to-day tasks, such as lifting a grocery bag or washing your hair, it’s a clear signal that you should set up an appointment for a shoulder examination.
• Cracking and popping sounds: While by no means a sole indication of OA, it can help the doctor diagnose the condition as it’s common in shoulder osteoarthritis patients.

During the exam, your doctor will investigate many factors, such as:

• Pain in certain positions
• Muscle strength
• Mobility – both passive and active range of motion
• Tenderness to the touch
• Other joints with signs of arthritis
• Signs of new or old injuries
• Swelling or joint enlargement
• Crepitus (popping or cracking sensation) with movement

You may also be asked to participate in several tests, including:

• X-rays
• Blood tests, mainly to look for rheumatoid arthritis, but also to exclude other diseases
• Removal of synovial fluid, the lubricating fluid in the lining (synovium) of the joint, for analysis
• MRI scans

How to Treat Shoulder Osteoarthritis?

There are several general treatment categories you could go for.

Non-Surgical Treatments

Many non-surgical options are employed to reduce pain and increase shoulder range of motion. The problem is that they do exactly that: they might help alleviate the pain and move more freely, but they do not fix the issue.

Once the shoulder joint cartilage is damaged, there’s no way to restore it with non-invasive methods.

Physical therapy is one of the most common, safest, and proven choices. The logic behind the treatment is sound: strengthen your shoulder, back, and arm muscles, and, through that, remove stress from the shoulder joint. This decelerates the wear-and-tear process and reduces pain.

This case study of a 38-year old male who suffered from shoulder OA showed a drop in “pain and disability scores” from 43% to 17% after a 5-session, 4-week exercise plan. It concludes that “nearly all patients with shoulder OA can benefit from physical therapy.”

However, physical therapy will not treat OA. The cartilage will continue to deteriorate, and the pain is likely to return.

Alternative treatments such as yoga, meditation, acupuncture can also help. It’s a light form of physical therapy—a means to alleviate the pain, not solve it.

Pharmaceutical options are also available to deal with the pain. To reduce discomfort, pain medications such as acetaminophen and anti-inflammatories such as nonsteroidal anti-inflammatory drugs (NSAIDs) can be utilized. To relieve pain, use topical analgesics such as NSAID gels, counterirritants, or capsaicin to the shoulder.

Surgical Options

If the pain-relieving options do not match your needs and you want a more permanent solution, you will be offered a range of surgical treatments.

Arthroscopy can be performed to clean the interior of the joint and remove bone spurs and loose cartilage fragments. Arthroscopy can help with discomfort, but it won’t cure your arthritis. It has been accurately classified as a means to manage shoulder OA, not treat it. Shoulder arthroscopy “appears to have better results in shoulders with a lesser degree of osteoarthritis.”

In more severe cases of shoulder osteoarthritis, shoulder replacement surgery may be suggested. In essence, the surgery removes a part of one of the shoulder joints and replaces it with an artificial one. 

According to this 2013 review, variations of shoulder replacement surgery “may achieve” a significant long-term improvement, but it is also likely to result in the need for revision surgeries.

Orthobiologic Methods

If nothing works for you, your doctor may suggest you use non-invasive methods, such as cell-based therapies or platelet-rich plasma (PRP) therapy. These treatments focus on “autologous tissues” and activate the regenerative qualities of our bodies. It’s the next frontier in medical advancement, and the results displayed so far are miraculous.

Cell-Based Therapies

These are also known as “stem cell therapies.” Depending on your shoulder condition, you’ll go through either of the two cell-based therapies:

• Minimally Manipulated Adipose Tissue Transplant (MMAT). This procedure targets the adipose tissues or cells and injects them in the injury site. It is a less painful method that can be performed in multiple locations of your body in the same procedure. 

• Bone Marrow Concentrate (BMAC). BMAC is the second most requested cell-based therapy that includes replacing damaged tissues with highly concentrated cells of your bone marrow. 

Both of these cell-based procedures are performed under anesthesia, so the patient feels minimum pain. It usually takes about 1.5-2 hours for the treatment to complete. These are outpatient procedures, which means your doctor will ask you to go home after the treatment. 

Platelet-Rich Plasma (PRP) Therapy

PRP focuses on stimulating the tissue growth in your affected body parts by injecting healing bodies, called platelets. The plasma in our blood contains platelets. They serve as the first line of defense in the healing process after an injury. 

These components also perform multiple functions. They send chemical signals to attract healing cells in the blood and produce a web-like sticky matter called fibrin. Platelets also release about 10 Growth Factors to trigger the growth of healthy tissues. 

Fibrin produces scaffolding for new, healthy tissues to start building. PRP is a crucial part of treating many orthopedic and spine conditions. The procedure is completed in about 45 minutes.