Shoulder Arthritis.
What is shoulder arthritis?
Shoulder arthritis is a degenerative or inflammatory condition affecting one or more of the joints that make up the shoulder complex — most commonly the glenohumeral joint (the main ball and socket joint) or the acromioclavicular (AC) joint. It produces progressive pain, stiffness and loss of shoulder function that can significantly limit daily activities, work and sport. While less common than knee and hip arthritis, shoulder arthritis is a significant cause of pain and disability — particularly in older adults and those with a history of shoulder injury.
Types of shoulder arthritis
Understanding which joint is affected and what type of arthritis is present guides both the physiotherapy approach and the surgical decision-making when conservative management reaches its limits.
Glenohumeral osteoarthritis (OA) — degenerative arthritis of the main shoulder joint — is the most common and most disabling type. It produces progressive cartilage loss at the humeral head and glenoid, with characteristic posterior glenoid wear that shifts the humeral head posteriorly and alters joint mechanics. Glenohumeral OA is more common in patients with a history of shoulder injury, previous surgery or inflammatory arthritis, and in overhead athletes with high lifetime joint loading. Advanced glenohumeral OA may progress to total shoulder replacement — see our dedicated shoulder replacement rehabilitation page.
Acromioclavicular (AC) joint osteoarthritis — degenerative arthritis of the small joint between the clavicle and acromion — is extremely common and frequently asymptomatic, but when symptomatic produces localised pain directly over the AC joint that is worse with cross-body movements, reaching across the chest and overhead activity. It is common in weight-training athletes from years of heavy pressing and in occupational overhead workers. AC joint OA also produces inferior osteophytes that narrow the subacromial space, contributing to subacromial bursitis and impingement.
Rheumatoid arthritis of the shoulder — inflammatory arthritis from immune-mediated synovial destruction — produces bilateral shoulder involvement with synovitis, pain, swelling and progressive joint destruction if not well controlled medically. The cervical spine is also commonly affected in rheumatoid arthritis, which has important implications for physiotherapy assessment and treatment.
Post-traumatic arthritis — developing after a shoulder fracture, dislocation or surgical procedure — is one of the most common causes of glenohumeral OA in younger adults. Previous shoulder dislocation, proximal humerus fracture and SLAP lesion repair all increase the long-term risk of glenohumeral arthritis.
Rotator cuff arthropathy — a distinctive pattern of glenohumeral arthritis developing after massive irreparable rotator cuff tears — occurs when chronic loss of rotator cuff function allows the humeral head to migrate superiorly, destroying the superior glenoid and acromion. It typically presents in older adults with long-standing rotator cuff pathology.
What are the symptoms?
Weakness in the shoulder muscles alongside deep joint pain — often described as inside the shoulder rather than at the surface — is characteristic of glenohumeral arthritis. Pain is typically worse with activity and at the extremes of range of motion, and may be present at rest and at night in more advanced stages. Progressive loss of shoulder range — particularly internal rotation and full elevation — develops as articular and capsular changes accumulate. Crepitus — grinding or grating sounds with shoulder movement — is common.
AC joint arthritis produces a more localised pain directly at the top of the shoulder, specifically provoked by cross-body reaching, sleeping on the side, and horizontal adduction. The painful arc of glenohumeral impingement may coexist if inferior AC osteophytes are narrowing the subacromial space.
What can physiotherapy do — and what it cannot
As with osteoarthritis at other joints, physiotherapy cannot reverse the underlying articular cartilage loss of shoulder arthritis. What it can achieve is clinically meaningful — managing pain, maintaining and improving shoulder range of motion and strength, slowing functional decline, and optimising the shoulder's capacity for the activities that matter most to the patient. For many patients with mild to moderate shoulder arthritis, this is sufficient to maintain acceptable function and avoid or delay surgery.
For advanced glenohumeral OA where conservative management has reached its limit and function is significantly compromised, total shoulder replacement or reverse total shoulder replacement may be appropriate. Physiotherapy plays an important pre-operative preparation role and is central to post-surgical rehabilitation.
How can physiotherapy help?
Physiotherapy can play a significant role in managing shoulder arthritis by helping to reduce pain, improve shoulder function and enhance the overall quality of life. Manual therapy — physiotherapists can use hands-on techniques such as joint mobilisations and soft tissue massage to alleviate pain and reduce muscle tension in the affected shoulder.
Joint mobilisation of the glenohumeral joint — using oscillatory techniques that move the joint through its available range — reduces pain through neurophysiological mechanisms and maintains the joint mobility that progressive capsular tightening would otherwise erode. Posterior capsule stretching — the posterior capsule is characteristically tight in glenohumeral OA, contributing to the loss of internal rotation — is one of the most important flexibility targets.
Rotator cuff and periscapular strengthening maintains the dynamic joint stability that compensates for the compromised articular surface. Strong rotator cuff muscles centre the humeral head in the glenoid, reducing the abnormal joint loading patterns that accelerate articular damage and produce pain. Scapular control work addresses the altered movement patterns that develop secondary to pain and restricted motion.
Activity modification and joint protection education — how to modify provocative activities, pacing strategies, appropriate load management and ergonomic advice — are important self-management components. Heat application — a heated wheat pack or warm shower — provides meaningful symptomatic relief for many patients with shoulder arthritis.
Dry needling of the periscapular musculature manages the secondary muscle tension and trigger points that accumulate around an arthritic shoulder. Real time ultrasound assists in retraining rotator cuff activation where pain has disrupted normal neuromuscular patterns. Clinical Pilates provides a controlled low-impact environment for progressive shoulder strengthening.
For patients with co-occurring conditions including cardiovascular disease or metabolic conditions where exercise physiology is appropriate, Ash O'Regan can provide exercise physiology through a Chronic Disease Management Plan with GP referral. For WorkCover patients whose shoulder arthritis is related to occupational loading, WorkCover funded physiotherapy is available.
Our physiotherapists Bethany Kippen and Emma Cameron both have experience in shoulder conditions and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Shoulder arthritis is a degenerative or inflammatory condition affecting one or more of the joints that make up the shoulder complex — most commonly the glenohumeral joint (the main ball and socket joint) or the acromioclavicular (AC) joint. It produces progressive pain, stiffness and loss of shoulder function that can significantly limit daily activities, work and sport. While less common than knee and hip arthritis, shoulder arthritis is a significant cause of pain and disability — particularly in older adults and those with a history of shoulder injury.
Types of shoulder arthritis
Understanding which joint is affected and what type of arthritis is present guides both the physiotherapy approach and the surgical decision-making when conservative management reaches its limits.
Glenohumeral osteoarthritis (OA) — degenerative arthritis of the main shoulder joint — is the most common and most disabling type. It produces progressive cartilage loss at the humeral head and glenoid, with characteristic posterior glenoid wear that shifts the humeral head posteriorly and alters joint mechanics. Glenohumeral OA is more common in patients with a history of shoulder injury, previous surgery or inflammatory arthritis, and in overhead athletes with high lifetime joint loading. Advanced glenohumeral OA may progress to total shoulder replacement — see our dedicated shoulder replacement rehabilitation page.
Acromioclavicular (AC) joint osteoarthritis — degenerative arthritis of the small joint between the clavicle and acromion — is extremely common and frequently asymptomatic, but when symptomatic produces localised pain directly over the AC joint that is worse with cross-body movements, reaching across the chest and overhead activity. It is common in weight-training athletes from years of heavy pressing and in occupational overhead workers. AC joint OA also produces inferior osteophytes that narrow the subacromial space, contributing to subacromial bursitis and impingement.
Rheumatoid arthritis of the shoulder — inflammatory arthritis from immune-mediated synovial destruction — produces bilateral shoulder involvement with synovitis, pain, swelling and progressive joint destruction if not well controlled medically. The cervical spine is also commonly affected in rheumatoid arthritis, which has important implications for physiotherapy assessment and treatment.
Post-traumatic arthritis — developing after a shoulder fracture, dislocation or surgical procedure — is one of the most common causes of glenohumeral OA in younger adults. Previous shoulder dislocation, proximal humerus fracture and SLAP lesion repair all increase the long-term risk of glenohumeral arthritis.
Rotator cuff arthropathy — a distinctive pattern of glenohumeral arthritis developing after massive irreparable rotator cuff tears — occurs when chronic loss of rotator cuff function allows the humeral head to migrate superiorly, destroying the superior glenoid and acromion. It typically presents in older adults with long-standing rotator cuff pathology.
What are the symptoms?
Weakness in the shoulder muscles alongside deep joint pain — often described as inside the shoulder rather than at the surface — is characteristic of glenohumeral arthritis. Pain is typically worse with activity and at the extremes of range of motion, and may be present at rest and at night in more advanced stages. Progressive loss of shoulder range — particularly internal rotation and full elevation — develops as articular and capsular changes accumulate. Crepitus — grinding or grating sounds with shoulder movement — is common.
AC joint arthritis produces a more localised pain directly at the top of the shoulder, specifically provoked by cross-body reaching, sleeping on the side, and horizontal adduction. The painful arc of glenohumeral impingement may coexist if inferior AC osteophytes are narrowing the subacromial space.
What can physiotherapy do — and what it cannot
As with osteoarthritis at other joints, physiotherapy cannot reverse the underlying articular cartilage loss of shoulder arthritis. What it can achieve is clinically meaningful — managing pain, maintaining and improving shoulder range of motion and strength, slowing functional decline, and optimising the shoulder's capacity for the activities that matter most to the patient. For many patients with mild to moderate shoulder arthritis, this is sufficient to maintain acceptable function and avoid or delay surgery.
For advanced glenohumeral OA where conservative management has reached its limit and function is significantly compromised, total shoulder replacement or reverse total shoulder replacement may be appropriate. Physiotherapy plays an important pre-operative preparation role and is central to post-surgical rehabilitation.
How can physiotherapy help?
Physiotherapy can play a significant role in managing shoulder arthritis by helping to reduce pain, improve shoulder function and enhance the overall quality of life. Manual therapy — physiotherapists can use hands-on techniques such as joint mobilisations and soft tissue massage to alleviate pain and reduce muscle tension in the affected shoulder.
Joint mobilisation of the glenohumeral joint — using oscillatory techniques that move the joint through its available range — reduces pain through neurophysiological mechanisms and maintains the joint mobility that progressive capsular tightening would otherwise erode. Posterior capsule stretching — the posterior capsule is characteristically tight in glenohumeral OA, contributing to the loss of internal rotation — is one of the most important flexibility targets.
Rotator cuff and periscapular strengthening maintains the dynamic joint stability that compensates for the compromised articular surface. Strong rotator cuff muscles centre the humeral head in the glenoid, reducing the abnormal joint loading patterns that accelerate articular damage and produce pain. Scapular control work addresses the altered movement patterns that develop secondary to pain and restricted motion.
Activity modification and joint protection education — how to modify provocative activities, pacing strategies, appropriate load management and ergonomic advice — are important self-management components. Heat application — a heated wheat pack or warm shower — provides meaningful symptomatic relief for many patients with shoulder arthritis.
Dry needling of the periscapular musculature manages the secondary muscle tension and trigger points that accumulate around an arthritic shoulder. Real time ultrasound assists in retraining rotator cuff activation where pain has disrupted normal neuromuscular patterns. Clinical Pilates provides a controlled low-impact environment for progressive shoulder strengthening.
For patients with co-occurring conditions including cardiovascular disease or metabolic conditions where exercise physiology is appropriate, Ash O'Regan can provide exercise physiology through a Chronic Disease Management Plan with GP referral. For WorkCover patients whose shoulder arthritis is related to occupational loading, WorkCover funded physiotherapy is available.
Our physiotherapists Bethany Kippen and Emma Cameron both have experience in shoulder conditions and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
