Shoulder Arthritis

Shoulder arthritis is caused by cartilage breakdown driven by age-related wear, prior injury, chronic rotator cuff deficiency, or systemic inflammatory disease. The underlying cause determines the subtype and, ultimately, the treatment pathway.

• Age-Related Degeneration: The most common pathway. Cartilage thins gradually over decades, eventually leading to bone-on-bone contact within the glenohumeral joint.
• Previous Trauma: shoulder dislocations, fractures, or earlier surgical repairs can accelerate joint deterioration. A single significant instability event in the twenties can present as arthritis in the fifties.
• Chronic Rotator Cuff Deficiency: When a large cuff tear goes unrepaired over a prolonged period, altered biomechanics allow the humeral head to migrate upward and grind against the acromion. This is a biomechanical consequence rather than a simple wear-and-tear process.
• Systemic Inflammatory Disease: Conditions such as rheumatoid arthritis inflame and erode the synovium directly.
• Repetitive Overhead Loading: High-load overhead activity, common in basketball, rock climbing, swimming, and heavy pull-based weight training, can accelerate glenohumeral degeneration even in younger patients. This is a pattern that age-focused causal frameworks tend to overlook.

Symptoms typically develop slowly over months to years rather than appearing suddenly. Common presentations include:

• Deep, aching pain in the shoulder that worsens with activity and often persists at rest
• Night pain that disrupts sleep, frequently the symptom that finally prompts a consultation
• Progressive stiffness, particularly loss of external rotation, so that reaching behind the back or across the body becomes difficult
• Grinding, clicking, or catching sensations during movement
• Weakness when lifting or carrying, often secondary to pain inhibition rather than true muscle failure
• Reduced tolerance for overhead tasks such as reaching a high shelf or hanging laundry

Stiffness alone does not confirm arthritis. Frozen shoulder produces a similar loss of motion through a completely different mechanism, and the two conditions follow different trajectories.

Treatment sits on a spectrum rather than presenting a binary choice between doing nothing and having surgery. The appropriate approach depends on the subtype, the severity of cartilage loss, rotator cuff integrity, and functional goals.

The sequencing is deliberate. Physiotherapy builds the muscular foundation that makes every subsequent step more effective, and structured non-operative programmes remain a reasonable starting point for many patients, as reflected in published reviews of conservative shoulder management. Injections function as a bridge rather than a destination, and the evidence base for injectable agents in shoulder osteoarthritis remains under active review.

Do You Need Surgery?

Surgery is typically considered when three to six months of appropriate conservative treatment has not restored acceptable function, and pain remains sufficient to disrupt daily life or sleep. Criteria assessed include duration and adequacy of prior conservative care, imaging findings, measurable functional decline, and the overall impact on quality of life.

Shoulder arthritis is a progressive condition with several distinct subtypes, and the subtype determines almost everything that follows: the symptoms you experience, the imaging findings, the treatment ladder, and which surgical options remain available. Conservative care is the appropriate starting point for many patients, and many manage well for years without surgery. Where surgery becomes appropriate, the choice between anatomic and reverse replacement rests on rotator cuff integrity rather than preference.

The practical takeaway is that timing preserves options. Seeking assessment while the cuff is intact and the joint is not yet severely eroded gives you more options than waiting until the shoulder dictates them. If shoulder arthritis is disrupting your sleep, your work, or your sport, a specialist consultation is a reasonable next step toward understanding where you sit on that spectrum.