Shoulder Osteoarthritis
What is it?
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Osteoarthritis is the most common form of arthritis that can affect any joint in the body. It is one of the leading causes of pain and disability. It presents as joint pain and stiffness (and sometimes swelling), with varying degrees of functional limitation, that can negatively affect someone’s quality of life.
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Within a joint, you have a tough slippery tissue called cartilage that covers the surface of the bones. This cartilage is there to protect the bones, help the bones to move against each other freely and to cushion the joint. Over the years, the cartilage gets thinner, and the surface becomes less smooth. This can cause the joint to feel stiff, and you may notice creaking sounds when moving.
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Sometimes the altered joint structure compensates for the changes and does not cause pain. It’s when the natural repair process cannot compensate enough that the joint starts to become painful.
Typical Symptoms/features:
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Stiffness or restriction of shoulder movements.
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Pain, particularly at night and difficulty finding a comfortable position.
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Difficulty carrying out activities such as brushing hair or reaching cupboards.
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Grinding, grating or clicking noises from the shoulder.
Management:
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Activity modification
- When you first start noticing pain, it may help to reduce your activity for a short amount of time to allow the pain to settle.
- However, there is strong evidence that says keeping active and slowly returning to your normal levels of activity can actually help the pain to settle quicker.
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Ice or heat.
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Pain relief.
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Physiotherapy including range of movement exercises and a graded strengthening programme.
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Orthopaedic options - In more severe and/or prolonged cases where pain is limiting conservative measures OR where 3-6 months of conservative management have failed to manage symptoms, then surgery such as a reverse total shoulder replacement may be appropriate.
Do I need imaging?
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In line with national guidelines (https://www.nice.org.uk/guidance/ng226/chapter/Recommendations), osteoarthritis should be diagnosed clinically WITHOUT imaging. This means that a healthcare professional should be able to diagnose osteoarthritis by asking you some questions about your pain and doing some tests to the joint in clinic.
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Everyone above the age of about 30 will have some age-related changes in their joints that can be seen on imaging. These changes do NOT mean that the joint is painful or not functioning well.
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There is a poor link between osteoarthritic changes visible on an x-ray and the symptoms felt; minimal changes can be associated with a lot of pain, or modest structural changes to joints can occur with minimal accompanying symptoms.
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This means that an x-ray result will likely not influence your treatment, and your management plan will be based instead around your pain, level of function and what you have tried so far.
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However, an X-Ray is likely needed if surgery is being considered.
