Osteoarthritis of the shoulder is a progressively degenerative disease that cannot be reversed. A variety of treatments are used to control pain and slow the disease's progression.

Unfortunately, there is a lack of clinical research that establishes which non-surgical shoulder arthritis treatments work best for which patients.6,7 This does not mean that the treatments available are not effective, but that often there is a process of trial and error regarding which treatments work best for which patients.

Without definitive clinical guidelines to direct non-operative treatment, it is imperative that the patient and doctor have a good relationship and talk frankly about hopes, expectations and risks of treatment. If the patient responds well to non-surgical treatment the degenerative process can be slowed down, pain can be controlled, and surgery can be avoided or at least postponed.

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Non-Surgical Treatments for Shoulder Osteoarthritis

Common non-operative shoulder arthritis treatments include:

Activity modification
Certain activities and exercise will aggravate the shoulder joint. Daily activities may need to be modified to avoid pain. Weight lifting, chopping wood, kayaking, and similarly intense shoulder activities may need to be avoided altogether.

Periodic rest
A little discomfort is to be expected as stiff joints loosen up in the morning or at the beginning of exercise. However, when people feel bone on bone pain or searing pain, they should not try to "work through the pain." Moderate to serious shoulder pain is a signal that the joint needs a rest.

Warm or cold compress
Using moist heat, such as a warming pad or whirlpool, for a few minutes can loosen a stiff shoulder joint making activity easier. Icing the shoulder joint for 15 or 20 minutes after activity can decrease swelling and provide some immediate pain relief. Heating or icing a joint is focused on improving symptoms temporarily: it does not alleviate the underlying causes of shoulder pain and will not improve long-term joint function by itself.

Physical Therapy
A physical therapy program that is focused on stretching and strengthening muscles and maintaining the shoulder's range of motion can be helpful. However, there is a lack of clinical research studying how physical therapy can benefit shoulder arthritis patients.8 Experts caution that aggressive physical therapy to expand range of motion can be detrimental to glenohumeral arthritis patients.9 A physical therapy program should proceed slowly to ensure the most benefit.

Medications and Injections for Shoulder Osteoarthritis

The medications listed below can be used to alleviate symptoms and slow the progression of shoulder osteoarthritis. Doctor and patient should discuss medication in the context of the patient's lifestyle, severity of pain and medical history. Potential side effects and interaction with other drugs and vitamins/supplements should also be considered.

  • Analgesics. Pain relievers, such as acetaminophen (e.g. the active ingredient in Tylenol) have relatively few side effects and relieve pain.
  • Non-steroidal anti-inflammatory drugs, or NSAIDs. Patients with moderate to severe pain may benefit from anti-inflammatory medications, such as aspirin, ibuprofen (e.g. Advil), naproxen (e.g. Aleve) or cox-2 inhibitors (e.g. Celebrex) to reduce the swelling and inflammation that are a common cause of pain. Prescription topical anti-inflammatory medications such as Voltaren gel and Flector patch may also be used.
  • Topical analgesics. These creams can be applied directly onto the shoulder. The creams contain counterirritants, such as wintergreen and eucalyptus, which stimulate the nerve endings and help distract the brain from joint pain. These creams are often sold over the counter and are available in most drug stores. Examples of brand names include Ben-Gay, Icy-Hot and Zostrix. Most can be used in combination with oral pain medications.

Glucosamine and chondroitin sulfate
Glucosamine sulfate and chondroitin sulfate occur naturally in the body's cartilage. In clinical trials conducted by the American College of Rheumatology, some patients with knee osteoarthritis reported benefits from taking supplements containing glucosamine sulfate or a combination glucosamine sulfate with chondroitin sulfate. Many experts agree more study is needed to fully understand how these alternative supplements affect the symptoms of osteoarthritis.10

Injections
Two types of injections are normally used for treatment of severe pain from shoulder osteoarthritis: steroid injections and hyaluronic acid injections.

  • The goal of steroid injections is to reduce swelling and thereby alleviate shoulder stiffness and pain.
  • The goal of hyaluronic acid injections is to provide lubrication for the shoulder joint, as hyaluronic acid mimics the viscous synovial fluid that naturally lubricates joints. Hyaluronic acid injections are a type of treatment called viscosupplementation.

The degree of pain relief from injections is variable. In a review of non-operative treatments for shoulder arthritis, the American Academy of Orthopaedic Surgeons found one clinical study supporting viscosupplementation but no rigorous studies to either support or discredit the use of steroid injections.11 Ideally, when injections are used they can be used in combination with a structured physical therapy program.

Many experts suggest that steroid and hyaluronic injections into the glenohumeral joint need to be done using fluoroscopy.12 Fluoroscopy is a radiographic imaging technique that allows doctors to conduct a procedure while watching a real-time X-ray movie, ensuring that the injection is made into the exact proper location. Ultrasound guidance can also be used to guide an injection into the glenohumeral joint and has the advantage of fluoroscopy of not containing any radiation.

Coping techniques
To manage the pain, patients may employ techniques such as relaxation (e.g. relaxation tapes, meditation), visual imagery, biofeedback or hypnosis. For many, these techniques, along with a positive attitude that focuses on what activities are possible, can have an impact in moderating the shoulder pain.

Surgery for Shoulder Osteoarthritis

If osteoarthritis symptoms are severe and other treatments don't succeed, surgery may provide relief.

Surgeries to relieve osteoarthritis of the shoulder include:

  • Shoulder arthroscopy to remove loose pieces of damaged cartilage.
  • Shoulder osteotomy to shave off osteophytes and reduce friction between bones.
  • Shoulder arthroplasty, or total joint replacement, to replace the ball-and-socket glenohumeral joint with an artificial one. The CDC reports that 41,934 total shoulder replacement (arthroplasty) surgeries were performed in 2004, making it the third most common joint replacement surgery, behind knee (454,652) and hip (232,857).13
  • Hemiarthroplasty, or partial joint replacement, to replace the humeral head. The employment of partial vs. total joint replacement is somewhat controversial. The AAOS reports that both can be successful, though pain relief and motion may be better with total joint replacement.14

For those who suffer from advanced shoulder arthritis, shoulder arthroplasty or hemiarthroplasty is a logical choice that can successfully decrease or eliminate pain. However, these are major surgeries that require a long recovery and rehabilitation process. Additionally, shoulder replacements have a limited lifespan. Doctors may advise younger patients with active lifestyles to pursue alternative treatments and procedures before having a joint replacement surgery. Patients are advised to choose a surgeon who is experienced in shoulder replacements.

References:

  1. Burbank K.M., Stevenson J.H., Czarnecki G.R., Dorfmon J., "Chronic Shoulder Pain: Part II. Treatment" Am Fam Physician, 2008 Feb 15; 77(4):493-497, http://www.aafp.org, accessed September 2011.
  2. "Shoulder Arthritis? What Patients Need to Know Before Treatment," American Academy of Orthopaedic Surgeons/American Association of Orthopaedic Surgeons, press release dated July 15, 2010, http://www6.aaos.org, accessed September 12, 2011.
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