Shoulder Arthritis

Types of shoulder arthritis

Primary osteoarthritis is the most common form and causes progressive cartilage loss, bone spurs, and deformity. Post-traumatic arthritis can follow a fracture, dislocation, instability, or cartilage injury. Rotator cuff tear arthropathy develops when longstanding cuff failure changes joint mechanics. Inflammatory arthritis and osteonecrosis can also damage the joint. This page addresses arthritis of the main glenohumeral joint. AC joint arthritis at the top of the shoulder is a separate condition.

Symptoms and evaluation

Symptoms include deep aching pain, pain at rest or at night, progressive stiffness, grinding, loss of strength or endurance, and difficulty with daily activities. The severity of an X-ray does not always match the severity of symptoms, so treatment is based on the whole clinical picture. X-rays show joint-space loss, bone spurs, deformity, humeral-head migration, and prior surgical or fracture changes. CT provides detailed three-dimensional evaluation of glenoid wear and bone loss. MRI or ultrasound may be used when rotator cuff integrity remains uncertain.

Nonsurgical treatment

Treatment may include modification of painful activity, appropriate medication, a directed home program or physical therapy, and a corticosteroid injection for temporary relief. Therapy should preserve useful motion and strength without repeatedly forcing a severely arthritic joint through pain. Hyaluronic-acid or viscosupplementation injections are not routinely recommended for glenohumeral osteoarthritis because evidence has not shown meaningful benefit.

When shoulder replacement is considered

Replacement may be considered when pain disrupts sleep or daily life, stiffness causes major functional loss, and reasonable nonsurgical treatment no longer provides acceptable relief. The decision is based on symptoms, anatomy, health, and goals rather than age or X-rays alone. Anatomic total shoulder replacement is generally used when the rotator cuff functions well and the anatomy can support a traditional reconstruction. Reverse shoulder replacement may be preferred when there is an irreparable cuff tear, major loss of active elevation, severe bone deformity, or another reason an anatomic implant would be unreliable. Hemiarthroplasty has a selective role.

Patient-specific planning and internal pathways

Dr. Knudsen plans every shoulder replacement with CT-based three-dimensional templating and uses augmented- or mixed-reality applications to support precise execution. The objective is to select the reconstruction that best matches the patient's bone, soft tissues, deformity, and functional priorities. Patients considering surgery should review the dedicated pages on Anatomic Shoulder Replacement, Reverse Shoulder Replacement, and Shoulder Replacement Surgery. Patients with new pain after a prior implant should visit Painful or Failed Shoulder Replacement.

Selected References

1. American Academy of Orthopaedic Surgeons. Management of Glenohumeral Joint Osteoarthritis: Evidence-Based Clinical Practice Guideline. AAOS; 2020.
2. Daher M, et al. Reverse versus anatomic total shoulder arthroplasty for glenohumeral osteoarthritis with intact cuff: a meta-analysis of clinical outcomes. J Shoulder Elbow Surg. 2025;34(1):190-202.
3. Piper C, Neviaser A. Survivorship of Anatomic Total Shoulder Arthroplasty. J Am Acad Orthop Surg. 2022;30(10):457-465.
4. Levine WN, Ahmad CS, Bigliani LU, Jobin CM, Knudsen ML, Luzzi AJ. From Neer to now—80 years of shoulder arthroplasty. JSES Int. 2025;9(3):934-943.

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