Degenerative conditions of the shoulder

Symptoms of degenerative shoulder conditions

Pain is usually the first sign, and it tends to get worse with activity before eventually being felt at rest too. It's often deep and aching if it comes from the main shoulder joint, or focused on top of the shoulder, sometimes spreading up the neck, if it comes from the smaller joint where your collarbone meets your shoulder blade.

You might also notice:

• weakness, or difficulty lifting your arm to shoulder height or above
• pain that disturbs your sleep or doesn't ease with over-the-counter painkillers
• stiffness that makes everyday tasks, such as washing your hair or reaching a shelf, more difficult
• a popping, grinding, clicking or squeaking noise when you move your shoulder.

Degenerative shoulder problems tend to develop from your late 40s onwards, while true arthritis of the shoulder is more often seen in your 60s and 70s. Many people put up with shoulder pain for a long time before seeking help, but it's worth getting it checked rather than waiting.

Causes and risk factors

Shoulder osteoarthritis, the most common degenerative shoulder condition, is described as either primary or secondary. Primary osteoarthritis has no single identifiable cause, but is linked to age, genes and sex, usually appearing after the age of 50 and affecting women more often than men.

Secondary osteoarthritis has a known trigger, such as a previous injury, a shoulder dislocation, infection, or a rotator cuff tear. Occupations involving heavy, repetitive use of the arms, such as construction work, and high-impact sports can also increase your risk.

A large, long-standing rotator cuff tear can itself lead to a type of arthritis, since the tendon can no longer hold the joint in its normal position, allowing the bones to rub together.

You may be more likely to develop a degenerative shoulder condition if you:

• are over 60, since your risk increases with age
• are female
• have previously dislocated or injured your shoulder
• have rheumatoid arthritis or another inflammatory joint condition
• have had a period of reduced blood supply to the shoulder joint, which can lead to bone damage known as avascular necrosis.

Are there different types?

Osteoarthritis is the most common type and is usually described as primary (no clear single cause) or secondary (following an injury, dislocation, infection or rotator cuff tear).

Other, less common types of arthritis can also affect the shoulder. Rheumatoid arthritis is an autoimmune condition where the body attacks its own joint tissue, and it can affect both shoulders at the same time. Rotator cuff arthropathy develops after a large, long-standing rotator cuff tear allows the joint surfaces to rub together. Avascular necrosis happens when part of the shoulder bone loses its blood supply and gradually collapses.

How are degenerative shoulder conditions diagnosed?

Your doctor will ask about your symptoms and medical history, including any previous injuries. They'll then examine your shoulder, checking your muscle strength, tenderness, and how far the joint moves both on its own and when guided.

They'll also look for grinding or clicking as the joint moves, swelling, and signs of arthritis in other joints. X-rays are usually the next step, and can show narrowing of the joint space, changes in the bone, and small bony growths called osteophytes, all of which point towards a degenerative condition.

How are degenerative shoulder conditions treated?

There's no cure for degenerative shoulder conditions, but treatment can ease pain, protect your mobility and help you stay active.

Non-surgical treatment

Self-care measures are usually tried first. These include changing activities that bring on pain, applying moist heat or an ice pack (ice for around three or four times a day can help reduce inflammation), and staying gently active to protect your strength and range of motion.

A physiotherapist can guide you through stretching and strengthening exercises tailored to your shoulder, building this up gradually as your symptoms allow.

Pain relief such as paracetamol, and anti-inflammatory medicines such as ibuprofen or naproxen, can help ease symptoms, and are best taken with food. Creams containing capsaicin or menthol are another option applied directly to the skin.

If these measures aren't enough, your doctor may suggest a corticosteroid (steroid) injection into the joint to reduce inflammation, or a viscosupplementation injection, which uses a lubricating fluid similar to your body's own joint fluid. If your arthritis is caused by rheumatoid disease, you may also be offered disease-modifying anti-rheumatic drugs (DMARDs), which work on the immune system rather than just easing symptoms.

Surgical treatment

Surgery is usually considered a last resort, kept for when pain and mobility haven't improved with other treatments.

For earlier-stage disease, keyhole (arthroscopic) surgery can be used to smooth or remove damaged cartilage and loose fragments of bone. This won't cure the arthritis, but can ease irritation from loose tissue and may help while the joint is only mildly affected.

For more advanced disease, shoulder replacement surgery (arthroplasty) is often the most effective option. This can involve replacing both the ball and socket surfaces of the joint, replacing only the ball (hemiarthroplasty), or, if your rotator cuff is too damaged to support a standard replacement, a reverse shoulder replacement, where the position of the ball and socket are swapped to let your remaining muscles move the joint instead.

In some cases where movement can't otherwise be restored, joint fusion (arthrodesis) may be considered instead, which stops movement at the joint altogether to relieve pain.

When should I see a doctor?

See a doctor if you have shoulder pain that doesn't settle with rest or over-the-counter painkillers, disturbs your sleep, or stops you lifting your arm to shoulder height or above. It's easy to put up with shoulder pain for a long time before seeking help, but an earlier diagnosis makes it easier to manage your symptoms and protect your movement.