Shoulder Osteoarthritis
Arthritis in the main ball-and-socket shoulder joint, causing a deep ache, stiffness and gradually lost movement, often with grinding. Less common than knee or hip arthritis and with fewer good trials, but shoulder replacement works well for many people with severe arthritis.
Symptoms. A deep ache in the shoulder, worse with use and often at night; growing stiffness reaching up, out or behind your back; and grinding or clicking.
Is it arthritis? Most shoulder pain is actually from the rotator cuff tendons or a frozen shoulder, which can feel similar. See our rotator cuff exercise handout for the common kind.
Who gets it. More likely with age, after a shoulder dislocation or fracture, with a long-standing large rotator cuff tear, and with inflammatory arthritis such as rheumatoid arthritis.
How it’s diagnosed. From an examination of how the shoulder moves, usually with an X-ray, because arthritis, frozen shoulder and rotator cuff problems can feel alike.
The shoulder osteoarthritis ladder
Honest version: there are few good trials for non-surgical treatment of shoulder arthritis, so most advice borrows from other joints. Start simple and safe, and climb if pain keeps limiting you.
- Step 1 · Self-careKeep it moving, and strengthen around itGentle daily range-of-motion exercises, plus shoulder-blade and rotator cuff strengthening as tolerated.
- Works
- Few trials in shoulder arthritis, and a US surgeons’ guideline called the evidence inconclusive. Advised because it’s safe and works for other joints
- Cost
- Free
- How long
- 6–12 weeks to judge; keep going
- Watch for
- Some soreness is normal. Fine if it settles within 24 hours.
A stiff shoulder gets stiffer when ignored.
- Step 2 · PharmacyAnti-inflammatory gel or tabletsGel on the shoulder, or a short course of tablets for flares.
- Works
- Shoulder-specific evidence is thin; modest relief in other arthritic joints
- Cost
- Gel about $15–30; tablets about $5–15
- How long
- Days to a couple of weeks
- Watch for
- Tablets: Stomach bleeds, kidney and heart risks. Not safe for many people: check with your GP or pharmacist.
A flare tool, not a lifestyle.
- Step 3 · Allied healthPhysioA tailored program to keep movement and strength, and advice on easier ways to do tasks.
- Works
- No good trials specific to shoulder arthritis; helpful for staying active and for the common look-alikes
- Cost
- About $90–130 a session; Medicare rebates for up to 5 allied health visits a year with a GP care plan
- How long
- A few sessions, then keep going at home
- Watch for
- Avoid forceful stretching into pain.
Coaching for your shoulder, not miracles.
- Step 4 · ProcedureSteroid injectionAn injection into the shoulder joint, usually with ultrasound guidance.
- Works
- Shoulder-specific evidence is inconclusive; in arthritis generally, modest relief lasting about 2–4 weeks on average
- Cost
- From bulk-billed to a few hundred dollars, depending on the clinic and whether ultrasound is used
- How long
- Weeks
- Watch for
- Not a long-term fix. Rare infection. Surgeons may want a gap of a few months before a replacement.
A pause button, not a fix.
- Step 5 · SpecialistShoulder replacementFor severe pain and lost function despite good non-surgical care. A “reverse” replacement is used when the rotator cuff is badly torn.
- Works
- Replacing both sides of the joint gives better pain relief and movement than replacing only the ball. In one UK study, about 9 in 10 people with arthritis said they’d have the operation again
- Cost
- Free in the public system (expect a wait); private out-of-pocket costs vary
- How long
- Sling for a few weeks, rehab for months
- Watch for
- Infection, stiffness, dislocation, nerve injury; younger, very active people may wear out an implant.
For the right person, a genuinely life-changing operation.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- PRP and stem cell injectionsFor shoulder arthritis, the evidence is case reports and small studies without comparison groups. Benefit is unproven, and costs are high.
- Arthroscopic “clean-out”A US surgeons’ guideline found no good evidence for or against it in shoulder arthritis. For knees, it’s no better than exercise.
- Hyaluronic acid (“gel”) injectionsNICE advises against them for osteoarthritis; shoulder evidence rests on a single industry-funded study.
- GlucosamineNICE advises against it for osteoarthritis.
What you can do
- Move your shoulder through its comfortable range every day, even in a flare.
- Keep things you use often between waist and shoulder height.
- Sleep with a pillow under the arm, or on your back, if night pain is an issue.
- Try our shoulder exercise handout: it’s written for rotator cuff pain, so ask your physio which moves suit an arthritic shoulder.
See your GP if
- Night pain is wrecking your sleep
- Movement keeps shrinking, or you can’t do your work or self-care
- You’ve had a dislocation or fall, then pain and weakness lifting the arm
- Pain hasn’t improved after 6 weeks of exercise and simple pain relief
Get urgent help for shoulder or arm pain with chest pain, breathlessness, sweating or nausea, as it can be a heart attack: call 000 (Australia) or your local emergency number. See a doctor the same day for a hot, swollen shoulder with fever, or a shoulder that looks out of place after a fall.
Common questions
How is shoulder arthritis different from a frozen shoulder?
Both cause stiffness. Frozen shoulder comes on over weeks to months and usually improves over 1 to 3 years. Arthritis develops slowly with grinding, and an X-ray shows joint changes. They can feel alike, so an examination and X-ray help.
Will exercise damage my shoulder more?
Sensible exercise isn’t known to speed up shoulder arthritis, and keeping the shoulder moving helps prevent extra stiffness.
When should I consider a shoulder replacement?
When pain and stiffness are severe despite good non-surgical care, especially if it’s affecting sleep or self-care. A surgeon will check the rotator cuff to choose the right type.
Do injections help?
A steroid injection may ease a bad flare for a few weeks. Shoulder-specific evidence is limited, and PRP and stem cell injections are unproven.
Helpful resources
- Shoulder exercise handoutPrintable, one page, written for rotator cuff pain. Free, from us.
- MyOA (Arthritis Australia)Trusted osteoarthritis information, plus symptom tracking and goal-setting tools. Free, Australia.
- Arthritis AustraliaInformation sheets and the free Arthritis Infoline (1800 011 041) for questions and local support. Free, Australia.
Evidence and more information
- AAOS: Guideline on shoulder (glenohumeral) osteoarthritis (2010)
- JBJS Reviews: PRP and cell therapies for shoulder osteoarthritis (2020)
- Journal of Bone and Joint Surgery (2010): Satisfaction after shoulder hemiarthroplasty
- NICE: Osteoarthritis diagnosis and management (2022)
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