Shoulder osteoarthritis is a condition involving the wearing down of cartilage that lines the shoulder joint. It also involves changes in the shoulder bones.

Three bones make up the shoulder joint.

• The humerus bone at the top of the arm has a ball-shaped head, covered with cartilage.
• The "ball' lines up with the glenoid, a saucer-shaped, cartilage-covered area of the shoulder blade (scapula) that acts as a "socket."
• The third bone is the collar bone (clavicle), which connects to the top of the shoulder blade.

The shoulder joint is surrounded and connected by ligaments and muscles that control the joint's movement and hold the shoulder together.

In a healthy shoulder, the cartilage allows the "ball" portion of the humerus to glide and rotate smoothly in all directions within the "socket." In the early stages of shoulder OA, small pits develop in the smooth cartilage. Eventually, small protrusions of bone (bone spurs) develop at the edges of joint surfaces. Joint fluid also may collect under the cartilage, forming cysts, which can put pressure on the bone and cause pain.

As OA worsens, the ligaments at the front of the shoulder become too tight or too loose due to bone and cartilage changes, making it hard for the shoulder joint to move properly. In addition, the rotator cuff (made up of the four main muscles that support the shoulder) may become overused, weakened, or torn. Around 90% of people with shoulder OA also have rotator cuff conditions.

In the late stages of shoulder OA, the cartilage can wear away completely, allowing bone-to-bone contact.

Physical therapy is the first recommended treatment for people who develop shoulder pain. A physical therapist can help you to decrease pain, improve movement, and increase your ability to use your shoulder for daily activities. Physical therapy also may help you delay or avoid surgery altogether, which can mean better long-term outcomes.

Without Surgery

A physical therapy program can help to improve your:

Ability to do daily activities. Your physical therapist will work with you to help you get back to doing your daily tasks. Just changing your posture can reduce the pressure and forces at the joint and help reduce your pain.

Pain management. Your physical therapist will provide treatments and advice to help control your pain, such as:

• How and when to use heat and ice.
• How to position your arm for comfort.
• How to move with less pain.
• How to modify your activities to avoid painful positions.

Shoulder mobility. Your physical therapist can recommend ways to restore the range of motion (movement) in your shoulder. They can teach you safe and specific ways to stretch your shoulder. These flexibility exercises can lengthen tight muscles and ligaments and improve your posture and movement. Your physical therapist may provide hands-on therapy for your shoulder joint to help improve movement and ease your pain. This may include gently moving your shoulder (manual therapy), to stretch the ligaments in ways that are hard to do on your own.

Muscle strength. Your physical therapist will help you strengthen your shoulder area and related body regions. Strengthening the rotator cuff muscles provides better support for the shoulder joint. This can reduce friction in the joint caused by the rough, arthritic surfaces (damaged cartilage) rubbing together. Your physical therapist also will guide you through exercises to strengthen your postural muscles to reduce stress on the shoulder joint.

Other options for treatment may include medications such as steroids or nonsteroidal anti-inflammatory drugs. Injections of steroid or anesthetic medications also may help, but any improvement may be minimal and temporary.

After Surgery

If you do have surgery, there are several options for treatment following the procedure. The results of shoulder surgery for OA are better when you are older, considering all treatment options. It is best to discuss these options with your doctor and physical therapist. Whether you have surgery, and the type of surgery will depend on:

• The degree of damage at the joint and its surrounding structures.
• Your age and other medical conditions.
• Your occupation and activity level.

Surgery types include:

Surgery to relieve pain. The goal of this type of surgery is to resolve symptoms. It does not restore or reconstruct the arthritic area. This type of surgery is best for people under age 65 with minimal cartilage problems. People in their 20s to 40s with many active years ahead also may benefit from this type of surgery.

Surgery to repair, restore, or reconstruct. Over the last several years, surgeons have developed new joint resurfacing techniques. This option is available for younger people who have shoulder OA but who are not yet ready for total shoulder replacement. Your doctor and physical therapist can describe these different techniques in detail for you.

Total shoulder replacement. Total shoulder arthroplasty is the medical term for a shoulder replacement. This often is the best surgery for older patients who have advanced OA. It requires good-quality bone at the shoulder joint and intact rotator cuff muscles. This procedure is best for people who do not do high-level activities (over head work for a job or sport, or significant amounts of heavy lifting).

Partial shoulder replacement. Shoulder hemiarthroplasty is the medical term for partial shoulder replacement. It is an option if the rotator cuff muscles are too weak or damaged to support and move the joint.

Reverse total shoulder replacement. This surgery is an option if the rotator cuff muscles have failed and cannot be repaired. It also is an option if the bone quality in the upper arm is not good. Certain people who have broken bones in their shoulder joint also may be candidates for this type of surgery.

Arthroscopy. Many shoulder surgeries can be done with this less invasive surgical method. A surgeon makes several small incisions in the skin and inserts pencil-sized instruments (with a camera) into the shoulder to repair damage to muscles, bone, ligaments, or joint tissues.

Physical therapy after surgery will vary based on the type of surgery you have had. Your physical therapy program may include:

Ensuring your safety as you heal. Your surgeon and physical therapist will work together as a team to return your shoulder to health. After surgery, you will need to do specific activities and exercises at the right times to allow for optimal healing. All surgical procedures modify your shoulder joint and its surrounding tissues. It may take several months to heal. Your physical therapist will monitor your condition, and offer precautions to help safely restore or repair your shoulder.

Aiding motion of the shoulder. After surgery, your shoulder will be sore and swollen. You may not feel like moving your arm. However, gentle motion is often recommended. Your physical therapist may move your arm or help you move your arm to begin to gently restore motion. After some surgeries, movement is restricted during initial healing using a sling. Your physical therapist and surgeon will choose the best options to help you recover and guide you through the process.

Strengthening the shoulder. Due to prior disuse or pain after surgery, your muscles may not be as strong as normal. If a muscle was repaired during surgery, you will have to let it heal for a specific amount of time. Your physical therapist will let you know what activities are safe to do to support the healing process.
Relieving your pain and swelling. Using manual (hands-on) therapies and other treatments, your physical therapist can help reduce your pain during exercise and daily activities. These treatments also can reduce swelling and aid healing.

Preventing falls. More than 10% of people have a fall after they have shoulder surgery. A fall can cause further damage to your shoulder, but also to other parts of your body. Your physical therapist will work with you on your balance and help reduce your risk of falling during this time.

Guiding your return to work and daily activities. Returning to work and everyday activities may be slow. Your physical therapist will guide you through the process to help you achieve the best results.

It is not possible to prevent osteoarthritis altogether, including osteoarthritis of the shoulder. However, you may reduce your risk for developing shoulder OA by:

• Staying moderately active.
• Using good body mechanics (posture and positioning) during lifting, especially over the head.
• Keeping your shoulder muscles strong.
• Maintaining the length of your shoulder muscles with stretching.
• Minding your posture.
• Maintaining proper balance, to minimize your risk for a shoulder injury that could lead to OA.

Your physical therapist can guide you through specific activities to keep your shoulder healthy. They also can provide you with a home exercise program to maintain improvements after your formal physical therapy sessions have ended. Eating healthy and exercising will help you maintain a healthy weight and healthy joints. Avoiding injuries to the shoulder joint will always help reduce your risk of developing shoulder OA.

All physical therapists are prepared through education and experience to treat a variety of conditions or injuries, including shoulder OA. You may want to consider:

• A physical therapist who is experienced in treating people with musculoskeletal (muscle, bone, and joint) problems. Some physical therapists have a practice with an orthopedic, geriatric, or sports focus.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic, geriatric, or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, a tool built by the American Physical Therapy Association, to help you search for physical therapists in your area.

General tips when you're looking for a physical therapist (or any health care provider):

• Get recommendations from family, friends, or other health care providers.
• Ask about the physical therapists' experience helping people with shoulder OA.
• Be prepared to describe your symptoms in detail and say what makes them better or worse.