Shoulder arthritis is wear of the smooth cartilage in the main ball-and-socket joint of your shoulder. It usually shows up as a deep ache, stiffness, grinding and pain at night, and it tends to creep in slowly over years.
Most people start with exercise, changes to how they use the arm, and pain relief. A cortisone shot can calm a flare, but the relief is SHORT-term.
Replacement comes up when pain wrecks your sleep and daily life despite all that. The type of replacement depends on one question: does your rotator cuff still work?
What it feels like
- A deep ache: felt inside the joint, often at the back of the shoulder, rather than a sharp pinch on the outside
- Stiffness in every direction: reaching up, reaching behind your back and turning the arm outward all get harder
- Grinding or clicking: you may feel or hear a crunch as you move the arm
- Night pain: lying on that side becomes hard, and the ache can wake you
- A slow course: good weeks and bad weeks, with a gradual trend over months to years
How it differs from other shoulder problems
- Frozen shoulder also stiffens the joint in every direction, but the X-ray looks normal. In arthritis, the X-ray shows the joint space narrowing and bony spurs. See frozen shoulder
- Impingement usually hurts on the outside of the shoulder when you lift the arm, and movement stays full. See shoulder impingement
- A plain X-ray is usually all that’s needed to diagnose shoulder arthritis. An MRI or ultrasound helps if your doctor needs to check the rotator cuff
What helps first
- Keep moving: gentle range-of-motion work most days helps you hold on to the movement you have. Resting the arm completely tends to make stiffness worse
- Strengthen what’s around the joint: the rotator cuff and shoulder blade muscles take load off the joint and help control the ball in the socket
- Change the task, not your life: keep heavy loads close to your body, use a step stool instead of reaching high, and break up long overhead jobs
- Pain relief: anti-inflammatory gels or tablets can help some people. Check with your doctor or pharmacist first, especially if you have stomach, kidney or heart problems
- Heat before, ice after: heat eases stiffness before exercise. Ice can settle a sore joint afterward
- Sleep setup: a pillow under the arm, or lying on the other side hugging a pillow, often cuts night pain
Exercise won’t regrow cartilage. The aim is a shoulder that hurts less and moves better with the joint you have.
Cortisone shots
- They can calm a bad flare: the relief usually lasts weeks to a few months, and some people get little benefit
- They don’t fix the joint: they are a window to get moving and exercising while pain is lower
- Repeated shots have limits: if you might have a replacement, ask your surgeon about the timing of any injection before surgery. See cortisone shot side effects
The X-ray doesn’t decide when you need surgery. Your sleep and your day do.
When to think about replacement
- Pain keeps you awake most nights despite pain relief and exercise
- Daily tasks are slipping away: washing your hair, dressing, reaching a shelf
- You’ve given exercise a fair go: usually several months of a proper program
- The X-ray and your symptoms match: a badly worn joint on X-ray with little pain doesn’t need surgery on its own
Total or reverse replacement?
- Total (anatomic) replacement: copies the normal shape, with a metal ball on the arm bone and a plastic socket. It relies on a working rotator cuff to keep the ball centered and to move the arm
- Reverse replacement: swaps the ball and socket around so the big deltoid muscle can lift the arm without the cuff. It’s the usual choice when the cuff is badly torn or worn out. See reverse shoulder replacement
- Your scan decides it: your surgeon will check the cuff with an MRI, ultrasound or CT before choosing
Realistic results
- Pain relief is the main win: most people sleep and function much better after a shoulder replacement
- Movement improves, but not always to normal: reaching behind your back and turning the arm outward may stay limited, especially after a reverse replacement
- They last well: about 9 in 10 shoulder replacements are still in place at 15 years without needing another operation
- Recovery takes months: a sling for the first few weeks, then a staged rehab program. Improvement often keeps coming slowly for many months. See shoulder replacement recovery
- Heavy loads and contact sport are usually off the table: your surgeon will give you limits. Use theirs
Get seen today if
- The shoulder is hot, red and swollen and you feel feverish or unwell. A joint infection needs urgent treatment
- You had a fall and now can’t move the arm, or the shoulder looks out of shape
- You have a replacement and the shoulder suddenly becomes hot, very painful or gives way
- Shoulder pain comes with chest pain, shortness of breath or sweating. Call emergency services
Get it checked if
- Night pain keeps waking you for several weeks despite treatment
- The arm is getting weaker, not just stiffer
- You have a history of cancer with constant pain, weight loss or night sweats
- Several months of exercise haven’t made a difference
Exercise gets most people a long way. When it stops being enough, a working cuff decides which replacement you get.