Shoulder Arthritis: When Surgery Is the Right Option

Overview

Shoulder arthritis, like hip and knee arthritis, involves the progressive breakdown of articular cartilage within the glenohumeral (shoulder) joint. While less common than hip or knee arthritis, it is an important cause of pain and disability, particularly in older adults.

Types of Shoulder Arthritis

Osteoarthritis is the most common form, degenerative wear of the cartilage. Rheumatoid arthritis is an autoimmune condition that commonly affects the shoulder. Post-traumatic arthritis follows prior shoulder fractures or dislocations. Rotator cuff arthropathy is a specific pattern of shoulder arthritis arising from a large, chronic rotator cuff tear with proximal migration of the humeral head.

Symptoms

• Deep shoulder pain, often worse at night
• Loss of movement — difficulty reaching overhead or behind the back
• Grinding or crunching with shoulder movement
• Stiffness, especially in the morning
• Weakness with overhead activities

Non-Surgical Treatment

Conservative measures include physiotherapy (range of motion and strengthening exercises), analgesics and anti-inflammatory medications, and intra-articular corticosteroid injections. Activity modification can reduce symptoms significantly in the earlier stages.

Total Shoulder Replacement

When conservative treatment is no longer adequate and arthritis is advanced, total shoulder replacement (TSA) is recommended. In an anatomic TSA, the humeral head is replaced with a metal ball, and the glenoid (socket) is resurfaced with a polyethylene component, replicating normal anatomy.

A reverse total shoulder replacement is used when there is significant rotator cuff deficiency (rotator cuff arthropathy or large irreparable rotator cuff tear). The ball and socket components are reversed, allowing the deltoid muscle to compensate for the deficient rotator cuff.

Outcomes

Total shoulder replacement has high patient satisfaction rates. Most patients experience significant pain relief and improved function. Recovery involves a sling for 4–6 weeks, followed by a structured physiotherapy program over 3–6 months. The majority of patients return to low-impact recreational activities by 3 months.

Further Reading

Dr Yu has written in more detail about this topic on his own site: shoulder arthritis and total shoulder replacement.