Shoulder Arthritis and Osteoarthritis Treatment
The shoulder contains two joints — the glenohumeral joint (the ball-and-socket where the upper arm bone meets the shoulder blade) and the acromioclavicular (AC) joint (where the collarbone meets the top of the shoulder blade) — and both can be affected by arthritis. When the protective cartilage lining either of these joints wears down, the resulting bone-on-bone contact produces chronic pain, stiffness, grinding, and a progressive loss of range of motion that can make everyday tasks like reaching overhead, dressing, sleeping comfortably, and driving increasingly difficult. Shoulder arthritis develops most commonly from age-related wear (osteoarthritis), prior injuries that altered the joint mechanics (post-traumatic arthritis), chronic rotator cuff disease that leads to abnormal joint loading (rotator cuff arthropathy), or inflammatory conditions such as rheumatoid arthritis. While there is no cure for arthritis, a wide range of effective treatments exist — from conservative measures that manage symptoms and slow progression to surgical options that can restore function and eliminate pain when the disease has progressed beyond non-operative management.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with a traveling shoulder fellowship under Dr. Charles Rockwood and Dr. Richard Hawkins and fellowship training at the Southern California Orthopedic Institute/UCLA. Shoulder arthritis requires a treatment approach calibrated to the type of arthritis, the specific joint involved, the condition of the rotator cuff, and the severity of the disease — and Dr. Glashow’s practice offers the full spectrum, from corticosteroid and viscosupplementation injections to arthroscopic debridement to anatomic and reverse total shoulder replacement. As Chief Medical Officer for the New Jersey Devils and Philadelphia 76ers — where post-traumatic shoulder arthritis from years of competition is a common long-term concern — and a Castle Connolly Top Doctor every year since 2000, he evaluates and treats shoulder arthritis at his Upper East Side practice in New York City.
Types of Shoulder Arthritis
Glenohumeral Osteoarthritis: The most common form of shoulder arthritis, occurring when the cartilage lining the ball-and-socket joint wears down over time from age, repetitive use, or prior injury. Pain is typically felt deep in the back of the shoulder and worsens with activity.
AC Joint Arthritis: Arthritis of the acromioclavicular joint at the top of the shoulder, often developing from prior AC joint injuries, weightlifting, or repetitive overhead work. Pain is localized to the top of the shoulder and worsens with cross-body reaching and overhead pressing.
Post-Traumatic Arthritis: Arthritis that develops following a previous shoulder injury — such as a fracture, dislocation, or surgical procedure — that altered the joint’s normal mechanics and accelerated cartilage breakdown.
Rotator Cuff Arthropathy: A specific pattern of arthritis that develops when a large, chronic rotator cuff tear goes untreated for an extended period. Without the rotator cuff to center the humeral head in the socket, the ball migrates upward and grinds against the acromion, producing a combination of arthritis, rotator cuff deficiency, and significant functional loss. This condition typically requires a reverse total shoulder replacement.
Symptoms of Shoulder Arthritis
- Pain that worsens gradually over months to years
- Stiffness and loss of shoulder range of motion
- Grinding, clicking, or crepitus during shoulder movement
- Pain at the top of the shoulder (AC joint arthritis) or deep in the back of the shoulder (glenohumeral arthritis)
- Difficulty reaching overhead, behind the back, or across the body
- Night pain that disrupts sleep
- Progressive weakness as pain limits use of the arm
Treatment Options
Conservative Treatment: The initial approach for most shoulder arthritis includes activity modification, anti-inflammatory medications, physical therapy focused on maintaining range of motion and strengthening the rotator cuff, corticosteroid injections to reduce inflammation and pain, and viscosupplementation (hyaluronic acid) injections to improve joint lubrication. Many patients experience meaningful relief with conservative care, particularly in earlier stages of the disease.
Arthroscopic Treatment: For patients with mild to moderate arthritis who have not responded adequately to injections and therapy, arthroscopic debridement — removing loose cartilage fragments, bone spurs, and inflamed tissue from within the joint — can provide symptomatic relief. For isolated AC joint arthritis, arthroscopic distal clavicle excision (resection of the end of the collarbone) eliminates the painful bone-on-bone contact and produces reliable long-term results.
Shoulder Replacement: When arthritis has progressed to the point where conservative and arthroscopic treatments no longer provide adequate relief, shoulder replacement surgery offers a definitive solution. Dr. Glashow performs both anatomic total shoulder replacement — in which the ball and socket are resurfaced with metal and plastic components — and reverse total shoulder replacement, which is designed specifically for patients with combined arthritis and rotator cuff deficiency (rotator cuff arthropathy). The choice between anatomic and reverse replacement depends on the condition of the rotator cuff, the pattern of bone loss, and the patient’s functional demands.
Shoulder Arthritis Treatment in New York City
If you are experiencing progressive shoulder pain, stiffness, or grinding that is limiting your daily activities, Dr. Glashow provides comprehensive evaluation with same-day X-rays and imaging at his Upper East Side practice to determine the type and severity of your shoulder arthritis and develop a treatment plan tailored to your condition. Contact our office to schedule your consultation.
Frequently Asked Questions About Shoulder Arthritis
What causes shoulder arthritis?
The most common cause is age-related wear and tear (osteoarthritis) — the gradual breakdown of the smooth cartilage lining the shoulder joint over decades of use. Shoulder arthritis also commonly develops after prior injuries such as fractures, dislocations, or rotator cuff tears that alter the joint’s mechanics and accelerate cartilage loss. Inflammatory conditions such as rheumatoid arthritis can affect the shoulder as well. Repetitive overhead sports and occupations — such as baseball, swimming, tennis, and construction work — increase the risk of developing shoulder arthritis earlier in life.
Which shoulder joint is more commonly affected by arthritis?
The AC joint (acromioclavicular joint) at the top of the shoulder is more commonly affected by osteoarthritis than the glenohumeral (ball-and-socket) joint. AC joint arthritis is particularly common in weightlifters and patients with prior AC joint separations. However, glenohumeral arthritis, while less common, tends to produce more significant functional limitation because the ball-and-socket joint is responsible for the majority of the shoulder’s range of motion.
How is shoulder arthritis diagnosed?
Dr. Glashow diagnoses shoulder arthritis through a clinical examination that assesses pain location, range of motion, strength, and crepitus, followed by X-rays that reveal joint space narrowing, bone spur formation, and changes in bone contour. An MRI may be ordered to evaluate the condition of the rotator cuff — which is critical for determining whether an anatomic or reverse shoulder replacement is most appropriate if surgery becomes necessary. Same-day imaging is available at his Upper East Side practice.
Can shoulder arthritis be treated without surgery?
Yes — many patients with shoulder arthritis achieve significant improvement with non-surgical treatment. The combination of anti-inflammatory medications, corticosteroid or viscosupplementation injections, physical therapy, and activity modification is effective for controlling symptoms in many patients, particularly those with early to moderate disease. Surgery is reserved for patients whose pain and functional limitation persist despite an adequate course of conservative care.
What is the difference between anatomic and reverse shoulder replacement?
An anatomic total shoulder replacement resurfaces the ball (humeral head) with a metal component and the socket (glenoid) with a plastic component, preserving the shoulder’s natural configuration. This design works well when the rotator cuff is intact and can continue to power the shoulder’s movements. A reverse total shoulder replacement switches the ball and socket — placing the ball on the socket side and the socket on the humeral side — which allows the deltoid muscle to power the shoulder instead of the rotator cuff. Reverse replacement is designed specifically for patients with combined arthritis and irreparable rotator cuff tears (rotator cuff arthropathy), where an anatomic replacement would fail because the rotator cuff cannot stabilize and move the prosthesis.
How long does a shoulder replacement last?
Modern shoulder replacement implants are designed to last 15 to 20 years or longer with normal use. Implant longevity depends on factors including the patient’s activity level, body weight, bone quality, and compliance with post-operative activity guidelines. Most patients experience significant pain relief and improved function that transforms their quality of life. Dr. Glashow discusses realistic expectations for implant durability, activity level, and long-term outcomes with each patient during the pre-operative planning process.
