Shoulder

Do You Have Shoulder Osteoarthritis? If So, What Can You Do About It?

“The pain started in my shoulders. The right one hurt first, and I had trouble lifting my arm, grasping things and even trying to shake someone’s hand.”

These are the words of Veritas Forums moderator named Ron, who openly shared his life-long story of battling arthritis.

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. It can be very demoralizing.

Due to the degenerative nature of the disease, it’s not going to go away on its own, either. And, when you start looking at treatment options, you’re faced with difficult tradeoffs: take away 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. But let’s start from the beginning.

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 the society. According to the OAA study in 2014, osteoarthritis cost on average $80 billion in lost earnings per year between 2008 and 2011. That’s billion, with a “b.”

Sandell, 2012, has concluded that “osteoarthritis was the highest cause of work loss and affected more than 20 million individuals, costing the U.S. economy more than $100 billion annually.”

Katlarz, 2011, has similarly 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.” That’s $11.6 billion, without factoring in the treatment and hospitalization costs.

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

While it’s easy to dismiss the pain of the millions, it’s almost impossible to ignore the suffering of each and every shoulder osteoarthritis patient. The disease restricts shoulder movement and the razor-sharp pain occurs upon movement and activity. You can get used to the mild, chronic pain. You can never get used to sharp, reactive, acute pain.

Is Osteoarthritis Dangerous?

Yes, it is. 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 sacred 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. The state of exhaustion OA patients find themselves in also often aggravates the pain.
  • Work and house chores. Some of the most disgusting life complications caused by shoulder osteoarthritis are those in our daily professional and personal lives. 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. It’s inevitable. You can’t sacrifice your work, and you can’t stop looking after yourself, your children and your house. However, you can pause your exercise regimen “until you get better.” This quickly turns into a fully sedentary lifestyle, weight problems and subsequent health issues—both physical and mental (this study has found that more than 40% of OA patients suffer from increased anxiety and depression).

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. Much like many moving parts in our cars need replacement over time, our body parts also wear down gradually, including the articular cartilage.

There are many key factors that 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 beating over the course of 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 worst thing about it is that the symptoms may not surface for years after the trauma, making diagnosis elusive.
  • Age. Age is a key factor in developing osteoarthritis. It’s only natural: over time, the articular cartilage is worn down, causing mobility and pain problems in the shoulder. In the US, shoulder osteoarthritis is prominent in “up to 32.8% of patients over the age of sixty.” According to WebMD, osteoarthritis “most often occurs in people who are over age 50.
  • Genetics. Some people simply are more prone to injury due to their bone alignment. This is dictated by genetics, and is out of our control. Poor bone alignment can cause bone dislocations and increase natural cartilage wear-and-tear. It is also shown that people whose family members have osteoarthritis are more likely to develop the condition.
  • Gender. Yes, 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. Pain is the most common symptom which pushes patients to visit the doctor’s office and investigate the issue. 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 back side 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 the 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 a number of factors, such as:

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

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. Here’s a short summary.

Non-Surgical Treatments

There are many non-surgical options that 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, most 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, while this 2013 review concludes that “nearly all patients with shoulder OA can benefit from physical therapy.”

Benefit they can. Solve the issue—hardly. 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. Pain relievers like acetaminophen and anti-inflammatories like nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to ease pain. Topical analgesics such as NSAID gels, capsaicin or counterirritants can be rubbed into the shoulder to reduce pain. Once again—a temporary solution.

Surgical Options

If not physical therapy, then what do you do to treat your arthritis? 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 used to clean out the inside of the joint, removing bone spurs and loose pieces of cartilage. Arthroscopy provides pain relief, but it will not eliminate 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 of revision surgeries.

Stem Cell Options

Stem cell treatment activates the regenerative qualities of our bodies. It’s the next frontier in medical advancement, and the results displayed so far are nothing short of miraculous.

The best thing about stem cell therapy is that they can truly heal the damaged shoulder cartilage. Through the activation of the natural building blocks of our bodies, stem cells repair the damaged tissue, solving the issue for good.

Read more about stem cell treatment options here.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni