Shoulder osteoarthritis
What is shoulder osteoarthritis?
Shoulder osteoarthritis is wear of the joint surface of the humeral head and glenoid socket. In primary shoulder osteoarthritis, the rotator cuff is usually intact. The wear pattern may be concentric, where the ball remains centred in the socket, or eccentric, where the humeral head sits more posteriorly and the socket can become worn or misshapen.
Cuff tear arthropathy is different. In that situation a large, long-standing rotator cuff tear changes the mechanics of the shoulder, allowing the humeral head to migrate upwards and the joint to deteriorate. This distinction matters because it often changes the type of shoulder replacement that is most appropriate.
Common symptoms
Pain is often felt deep in the shoulder or upper arm and may be worse with reaching, lifting, dressing, sleep, gym work or overhead activity. Stiffness, grinding, weakness and loss of confidence using the arm are also common.
Diagnosis and imaging
Assessment combines your symptoms, shoulder movement, strength and imaging. X-rays are usually the starting point. CT can help assess glenoid bone shape and version when planning shoulder replacement. Ultrasound or MRI may be used to assess the rotator cuff if the diagnosis or surgical plan depends on tendon quality.
Non-surgical treatment
Early treatment can include activity modification, physiotherapy to preserve movement and strengthen the remaining shoulder muscles, anti-inflammatory medication when suitable, and injections in selected cases. These measures may reduce symptoms, but they do not reverse established arthritis.
Surgical treatment
Surgery is considered when pain, stiffness or loss of function remains unacceptable despite appropriate non-surgical care. Options may include an anatomic total shoulder replacement for selected patients with an intact cuff and suitable anatomy, or reverse shoulder replacement when there is cuff tear arthropathy, major cuff dysfunction, deformity or bone loss.
Recovery and follow-up
Recovery focuses on pain control, protection of the repair or replacement, progressive movement and structured strengthening. The exact rehabilitation plan depends on the procedure performed, tendon quality, bone quality and your functional goals.
Shoulder osteoarthritis FAQs
What is the difference between primary shoulder osteoarthritis and cuff tear arthropathy?
Primary shoulder osteoarthritis usually means the joint surface has worn while the rotator cuff remains intact. Cuff tear arthropathy occurs when a large, long-standing rotator cuff tear changes shoulder mechanics and the joint becomes arthritic.
This distinction can influence whether an anatomic or reverse shoulder replacement is considered.
What imaging is needed to assess shoulder osteoarthritis?
X-rays are usually the starting point because they show joint space narrowing, bone spurs and the wear pattern. CT may be helpful when planning shoulder replacement because it shows the shape and version of the socket. Ultrasound or MRI may be used if the rotator cuff needs closer assessment.
Can shoulder osteoarthritis improve without surgery?
Symptoms can often be managed for a period with activity modification, physiotherapy, strengthening, medication when appropriate and selected injections. These options can reduce pain and improve function, but established joint wear does not usually reverse.
When is shoulder replacement considered?
Shoulder replacement may be considered when advanced shoulder arthritis causes persistent pain, night pain, stiffness, loss of strength, or loss of function despite appropriate non-surgical treatment. The decision is highly individual and depends on the pattern of joint wear, the condition of the rotator cuff, glenoid ("socket") bone loss, patient goals, activity level and overall health.
If shoulder replacement is being considered, A/Prof Ernstbrunner routinely arranges a CT scan for advanced preoperative planning. This allows detailed computer-based analysis of each patient's unique anatomy, including the shape, version and wear pattern of the glenoid ("socket"). He routinely uses patient-specific surgical planning and patient-specific guides for shoulder replacement surgery, allowing the reconstruction to be tailored to the individual anatomy and supporting precise implant positioning.
Reconstructive Orthopaedics Melbourne (ROM)
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