What are the stages of shoulder arthritis?
The shoulder joint is the third most common large joint affected by arthritis, usually seen in people over 50. Shoulder osteoarthritis refers to the wear and tear changes that lead to thinning or loss of the cartilage. The cartilage is the special protective tissue that covers the surface of the bone at the joints to ensure smooth and frictionless movement. In severe osteoarthritis, the loss of cartilage will result in the bones becoming bare (exposed) and rubbing against each other. This can result in significant joint pain, swelling and reduced function. In severe cases, there might be crepitus (a grating sensation due to bone-on-bone rubbing). To find out more, please see our article about shoulder osteoarthritis.
Relevant shoulder anatomy
The shoulder joint (the glenohumeral joint) is a ball and socket type joint. The ball is formed by the humeral head (the upper end of the arm bone), and the socket is formed by the glenoid, the part of the shoulder blade that articulates with the humerus. Both the ball and socket are covered by “cartilage”.
How is shoulder osteoarthritis diagnosed?
Imaging is very useful and usually needed to confirm the diagnosis of shoulder osteoarthritis. A shoulder X-ray is usually the first scan to assess the degree of joint space narrowing. Sometimes, more advanced imaging (an MRI scan) is required to provide more information about the state of the articular cartilage. Ultrasound is very useful in assessing the presence of fluid within the shoulder joint (referred to as shoulder joint effusion) and guiding intra-articular shoulder joint injections.
What are the stages of shoulder joint osteoarthritis?
There are 4 stages of osteoarthritis
In this stage, there is usually very little thinning to the articular cartilage. The symptoms are usually very mild, with an occasional “twinge”.
Stage 2 (mild)
In this stage, there is a slightly higher degree of thinning to the articular cartilage, but the cartilage remains to cover the bone ends within the joint (no exposed bone). The symptoms at this stage usually consist of mild generalised pain and stiffness, especially after inactivity in the morning. The pain can get worse with activities like walking or using the stairs.
Stage 3 (moderate)
The cartilage loss here is more advanced, and there are usually a few areas of full-thickness cartilage fissuring, resulting in small areas of exposed bone. The x-ray will show obvious findings of arthritis in terms of narrowing of the joint space and formation of small areas of bone overgrowth at the joint (referred to as osteophytes). The symptoms will be more advanced than stage 2, and there might be occasional grating sensations (crepitus). The shoulder joint may swell due to fluid accumulation within the joint (joint effusion).
Stage 4 (severe)
This is the most advanced stage of the disease. There will be significant areas of complete loss of the articular cartilage, resulting in complete exposure of the bone surfaces, and the bones will start to rub against each other. This usually results in severe pain that could be experienced at rest and can also interfere with sleep. This stage is usually associated with significant limitations of function.
How to treat shoulder joint arthritis?
Shoulder osteoarthritis treatment usually starts with physiotherapy and anti-inflammatory tablets. People with mild osteoarthritis usually respond very well to a combination of physiotherapy and a progressive rehabilitation program. if the shoulder arthritis is severe and not responding to the management above, an injection may be indicated.
Will I benefit from a shoulder injection for my arthritis?
This can be very useful in reducing pain, allowing you to undertake effective physiotherapy. One injection option is an ultrasound-guided steroid injection. This can provide rapid pain relief and is usually followed by a course of physiotherapy to utilise the window achieved by the injection. Hyaluronic acid injections can provide an alternative to steroids in the management of shoulder arthritis. They are usually used for mild to moderate osteoarthritis. In ultrasound-guided shoulder joint injections, the ultrasound visualises the needle, guiding it accurately to the target site. There is plenty of evidence showing that ultrasound-guided injections are more accurate, less painful and produce better results compared to non-guided injections.
Other alternative treatment options include:
Suprascapular nerve block. In this procedure, a mixture of numbing medications (local anaesthetic) and steroids is injected around the suprascapular nerve using ultrasound guidance. This will help to stun the nerve for a period of time and block the nerve fibres that transmit pain information to the brain. To find out more, please read our article about suprascapular nerve block.
Shoulder replacement is usually the last reserve for those with severe osteoarthritis that is not improving with injections and physiotherapy.
Shoulder conditions and treatments