Shoulder Arthritis
Shoulder Arthritis: Diagnosis, Treatment, and Shoulder Replacement in Houston
Shoulder arthritis is wear of the cartilage in one of the two joints of the shoulder complex—either the glenohumeral (ball-and-socket) joint or the acromioclavicular (AC) joint. It causes pain, stiffness, and progressive loss of motion. Most patients are first treated non-operatively, but when arthritis is advanced and symptoms can no longer be controlled, shoulder replacement is one of the most reliable operations in orthopaedics for pain relief and functional recovery.
Anatomy of the Shoulder
The shoulder complex contains two main joints:
- The glenohumeral (GH) joint is the ball-and-socket joint between the head of the humerus and the glenoid (a shallow socket on the shoulder blade). It is responsible for the shoulder's wide range of motion.
- The acromioclavicular (AC) joint is the small joint between the collarbone and the acromion (the bony roof of the shoulder). It moves a small amount with shoulder motion and can be a source of pain when arthritic.
Cartilage covers the surfaces of both joints, allowing smooth, painless motion. When this cartilage wears down, bone rubs on bone, causing pain, stiffness, and inflammation.
Types of Shoulder Arthritis
Three types of arthritis are commonly seen in the shoulder:
- Osteoarthritis (OA) is the typical "wear-and-tear" arthritis, usually appearing later in life. Post-traumatic OA can develop years after a shoulder fracture or significant injury.
- Inflammatory arthritis (such as rheumatoid arthritis) can affect the shoulder at younger ages and typically involves multiple joints throughout the body.
- Rotator cuff tear arthropathy is a distinct form of arthritis that develops when a long-standing massive rotator cuff tear allows the humeral head to migrate upward and erode the underside of the acromion. This pattern typically requires reverse shoulder replacement rather than anatomic replacement.
Symptoms
Shoulder arthritis typically causes:
- Deep, aching pain (often felt in the back of the shoulder or extending down the arm)
- Progressive stiffness and loss of motion, especially external rotation
- Grinding, grating, or popping (crepitus) with movement
- Pain at night that disturbs sleep
- Difficulty with overhead activities, dressing, and reaching behind the back
The pace of progression varies. Some patients remain stable for years on non-operative treatment; others progress more quickly to disabling pain.
Diagnosis
Diagnosis is made with a focused history, physical examination, and X-rays. Classic X-ray findings include joint space narrowing, bone spurs (osteophytes), and remodeling of the humeral head and glenoid. MRI is sometimes added to assess rotator cuff integrity, particularly when surgery is being considered—the choice between anatomic and reverse replacement depends in part on cuff status.
Non-Surgical Treatment
For most patients, treatment begins with non-operative options:
- Anti-inflammatory medication (NSAIDs) such as ibuprofen, naproxen, or prescription COX-2 inhibitors when appropriate
- Activity modification to avoid the most aggravating motions
- Physical therapy focused on maintaining motion, strengthening surrounding muscles, and improving function
- Corticosteroid injections into the glenohumeral or AC joint, which can provide several months of pain relief and help confirm the diagnosis
- Hyaluronic acid (viscosupplementation) is used in some patients, though evidence in the shoulder is more limited than in the knee
Most patients are managed non-operatively for as long as symptoms remain tolerable.
Surgical Treatment: Shoulder Replacement
When non-operative treatment is no longer effective and arthritis is advanced, surgery is considered. The two main options are anatomic and reverse shoulder replacement, with selection driven by the patient's anatomy, rotator cuff status, and goals.
Anatomic Total Shoulder Replacement
Anatomic total shoulder replacement recreates the native ball-and-socket anatomy. The humeral head is replaced with a metal ball on a stem (or in some cases a stemless implant), and the glenoid is resurfaced with a polyethylene component. It is the preferred option when the rotator cuff is intact and functional. Pain relief and motion recovery are highly reliable for appropriate candidates.
Reverse Shoulder Replacement
Reverse shoulder replacement inverts the normal anatomy—a metal ball is fixed to the glenoid, and a socket replaces the humeral head. This design allows the deltoid muscle to lift the arm when the rotator cuff is no longer functional. Reverse replacement is used for cuff tear arthropathy, massive irreparable rotator cuff tears with significant weakness, certain complex fractures of the proximal humerus, and many revision cases.
Outpatient Shoulder Replacement
For appropriate candidates, shoulder replacement can be safely performed as an outpatient procedure, with the patient going home the same day. Modern anesthesia (often regional nerve blocks), multimodal pain control, and structured recovery protocols make this safe and effective. Dr. Gregory has been involved in developing and publishing national standards for outpatient shoulder arthroplasty.
Arthroscopic Surgery for Early Arthritis
For carefully selected patients with mild to moderate arthritis—often younger or more active patients who want to delay replacement—arthroscopic debridement may improve symptoms. This procedure removes loose cartilage, inflamed tissue, and bone spurs but does not change the underlying arthritis.
AC Joint Surgery
When the AC joint is the primary source of arthritis pain and does not respond to injection or therapy, arthroscopic distal clavicle excision is highly effective. Through small incisions, the arthritic end of the collarbone is removed, eliminating the painful bone-on-bone contact. Recovery is typically quicker than glenohumeral surgery.
Further patient education is available in this handout.
Scheduling Your Visit
Appointments for shoulder arthritis evaluation and shoulder replacement consultations are scheduled through UTHealth Houston at 713-486-1700. The practice has offices in Memorial Villages and the Texas Medical Center.
Frequently asked questions
What are the symptoms of shoulder arthritis?
Shoulder arthritis typically causes deep, aching shoulder pain (often felt in the back of the shoulder), progressive stiffness and loss of motion, grinding or grating with movement, and difficulty sleeping or performing overhead activities.
How is shoulder arthritis diagnosed?
Diagnosis is made with a careful exam and X-rays. Findings include joint space narrowing, bone spurs (osteophytes), and changes to the shape of the humeral head or socket. MRI is sometimes obtained when the rotator cuff status needs to be confirmed for surgical planning.
Can shoulder arthritis be treated without surgery?
Yes—at least initially. Activity modification, anti-inflammatory medication, physical therapy, and corticosteroid injections relieve symptoms for many patients. Surgery is considered when arthritis is advanced and pain or stiffness can no longer be controlled non-operatively.
When is shoulder replacement recommended?
Shoulder replacement is considered when X-rays confirm advanced arthritis, when pain interferes with sleep or daily life, and when non-operative treatment is no longer effective. The decision is highly individualized and depends on age, activity level, rotator cuff status, and overall health.
What is the difference between anatomic and reverse shoulder replacement?
Anatomic total shoulder replacement preserves the normal ball-and-socket configuration and is used when the rotator cuff is intact. Reverse shoulder replacement swaps the ball and socket so that the deltoid muscle can lift the arm—used when the rotator cuff is deficient, in many revision cases, and for complex fractures.
How long does a shoulder replacement last?
Most modern shoulder replacements function well for fifteen to twenty years or longer, though outcomes depend on the implant type, the patient's activity level, and bone quality. Long-term registry data continue to track durability across implant designs.
Is shoulder replacement an outpatient procedure?
For appropriate candidates, yes. Many anatomic and reverse shoulder replacements can be safely performed as same-day surgery using modern anesthesia, pain control, and recovery protocols. Dr. Gregory has helped develop national standards for outpatient shoulder arthroplasty.
How long is recovery after shoulder replacement?
A sling is typically used for several weeks, motion is restored gradually over three months, and strengthening progresses through six months. Most patients return to driving and light work within a few weeks and to most recreational activities within several months.