Shoulder arthritis

What it is

Glenohumeral osteoarthritis is wear of the cartilage in the shoulder joint proper. It is far less common than rotator cuff problems, which is why shoulder pain is so often assumed to be the cuff, and it produces a different picture: progressive stiffness in all directions, grinding on movement, and pain deep in the joint.

The key distinguishing feature is loss of passive range. A cuff problem hurts to move actively and can usually be moved further by someone else; an arthritic shoulder is limited whoever moves it, particularly in external rotation, and it grinds.

What it feels like

• Deep aching pain in the shoulder, worse with use and often at night
• Progressive stiffness in every direction, particularly turning the arm outward
• Grinding or crunching felt through the joint on movement
• Difficulty reaching overhead, behind the back and across the body
• Gradual onset over years rather than a specific injury

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Cartilage loss in the joint

The cartilage on the ball and socket thins and wears, the joint space narrows and bone spurs form. It is the same process as in any other joint, in a joint where it is comparatively uncommon.

Previous injury

A previous fracture, dislocation or significant joint surface injury substantially raises the risk of arthritis decades later. Post-traumatic arthritis is a large share of shoulder arthritis in younger patients.

Recurrent dislocations

Repeated instability damages the joint surface and the socket rim. Long-standing instability is a recognised route to arthritis.

Cuff tear arthropathy

A large chronic rotator cuff tear allows the humeral head to ride upward and grind against the acromion, producing a distinct pattern of joint destruction. It is a different problem with different surgical options.

Age

Prevalence rises with age, though shoulder arthritis remains substantially less common than hip or knee arthritis at any age.

Heavy occupational or sporting loading

Weightlifting, manual work and overhead sport all load the joint and are associated with a higher incidence.

Inflammatory arthritis

Rheumatoid arthritis affects the shoulder and produces a more rapidly destructive picture that needs different medical management.

Avascular necrosis

Loss of blood supply to the humeral head, from steroids, sickle cell disease, alcohol or trauma, causes the bone to collapse and the joint to wear. It is a distinct cause worth knowing about.

Genetics

As with osteoarthritis generally, a family history raises risk.

Progressive stiffening from disuse

A painful shoulder is used less, which loses range and strength, which reduces function further. A great deal of the disability is from this rather than from the cartilage.

Who tends to get it

• Older adults, though it is less common than hip or knee arthritis
• Anyone with a previous shoulder fracture or dislocation
• People with recurrent shoulder instability
• Anyone with a large long-standing rotator cuff tear
• People with inflammatory arthritis or a history of significant steroid use

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineShoulder Relief & Overhead Range

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Night pain with fever; sudden loss of movement after trauma; a grinding shoulder that is also weak and unstable

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Exercise improves pain and function and maintains the range that determines what someone can actually do, though it does not change the joint. Progression is usually slow over years. Shoulder replacement is a reliable operation for pain relief in advanced arthritis, and reverse replacement is available where the rotator cuff has also failed - so persistent, limiting pain is worth a surgical opinion rather than enduring. Going in with better range and strength produces better results.

Prevalence basis: Shoulder epidemiology

Others the same routine covers

These share the Shoulder Relief & Overhead Range routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.