Shouldering the Burden

How shoulder arthritis impacts quality of life for older adults

Fact checked by Derick Wilder

Shoulder arthritis affects an estimated 1 in 3 Americans over age 60, causing pain that robs them of sleep and impacts their ability to function. But now more than ever, people have promising possibilities to reduce their pain and increase their range of motion.

The shoulder joint allows for a wide range of motion essential for everyday tasks such as reaching, lifting, and carrying. However, when arthritis takes hold, once-fluid movement becomes painful and restricted. Shoulder arthritis is frequently dismissed as overuse or strain. But as symptoms worsen, the harsh reality of arthritis often reveals itself.

Osteoarthritis, often called wear-and-tear arthritis, is the most prevalent type. However, shoulder arthritis can include various other forms, says Matthew Saltzman, MD, an orthopedic sports medicine specialist at Northwestern Medicine. While overuse of the joint is the leading cause of osteoarthritis, Saltzman says other factors such as genetics, trauma, and age contribute to its development.

“It’s more common to have arthritis as you age because your cartilage thins over time,” Saltzman says. The thinning leads to more friction between the bones.

“We also see it in people who do heavy weightlifting,” Saltzman says. “If they’re loading their joints with heavy weights, they can have it at an earlier age.” He adds that people who have had a dislocated shoulder have cartilage damage, which also often leads to arthritis over time.

Understanding family history and risk factors is important in recognizing the genetic aspect of shoulder osteoarthritis. Families with a history of shoulder arthritis might have a higher chance of developing the condition, but scientists have yet to identify specific genetic markers for it.

Diagnosing shoulder osteoarthritis typically involves a combination of patient history, physical examination, and X-rays, revealing characteristic signs such as joint space narrowing and bone spurs. “X-rays are very accurate at diagnosing osteoarthritis,” Saltzman says.

There is no cure for osteoarthritis, as treatment plans consist of managing the symptoms. So the journey to a pain-free shoulder often begins with education and lifestyle modifications. Anti-inflammatories, heating pads or ice, and adjustments in activity levels can help ease symptoms. Physical therapy is also crucial to maintain range of motion and strengthen the muscles surrounding the shoulder joint.

Medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections, offer temporary relief from pain and inflammation. However, their efficacy varies among individuals, along with concerns about potential side effects with long-term use. And supplements like glucosamine chondroitin or anti-inflammatory diets may certainly reduce joint swelling, but physicians agree: Nothing rebuilds cartilage.

There is no cure for osteoarthritis, as treatment plans consist of managing the symptoms. So the journey to a pain-free shoulder often begins with education and lifestyle.

Arthroscopic procedures, aimed at addressing structural abnormalities and removing damaged tissue, offer a minimally invasive surgical approach. However, for people with advanced arthritis or irreparable joint damage, total shoulder replacement typically restores function and alleviates pain for most.

About 90% of patients are happy with their shoulder replacements, Saltzman says. He credits the evolution of shoulder replacement implants, noting the development of smaller components that preserve more bone and allow for easier revisions if needed. He also notes that the use of augmented-reality surgery, technology that enhances surgical precision by providing real-time imaging during procedures, is intriguing.

Anthony Romeo, MD, orthopedic sports medicine specialist at Duly Health and Care, agrees. Romeo stresses the transformative impact of a technique called reverse shoulder replacement, particularly for individuals with rotator cuff deficiencies or complex shoulder pathology. In a reverse shoulder replacement, the ball and socket structure is reversed, with the artificial ball attaching to the shoulder blade and the artificial socket attached to the top of the arm bone.

“Reverse shoulder replacement bypasses the limitations of traditional methods,” Romeo says. The approach offers improved stability and function, especially for people with rotator cuff deficiencies. And significant advancements over the past two decades have shown promising results 20 years post-surgery, he adds.

Saltzman acknowledges ongoing research in osteoarthritis treatment, but stresses the need for long-term data to assess the effectiveness of improved techniques and materials, adding that biogenetics — using science to regenerate cartilage, for example — may need much more time to develop.

“The holy grail would be regenerating cartilage,” Saltzman says. “We can certainly do it in a petri dish in a lab, but the problem is — how do you get it into the shoulder joint? It needs to stay attached there and then grow cartilage cells. I think it’s definitely a possibility, but we’re pretty far away from being able to do that.”

Originally published in the Summer/Fall 2024 print issue