What is the condition?

Shoulder arthritis occurs when the cartilage lining the shoulder joint wears down, leading to pain, stiffness, and reduced movement. It commonly affects the glenohumeral joint (where the humeral head meets the socket of the shoulder blade).

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What are the symptoms?

· Deep, aching pain in the shoulder, often worse with movement

· Stiffness and loss of shoulder mobility

· Pain that may disturb sleep or daily activities

· Grinding, catching, or creaking sensation in the joint

· Weakness or difficulty lifting the arm

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What are the risk factors?

· Age-related (osteoarthritis), typically over 60

· Previous shoulder injuries (e.g. fractures, dislocations)

· Inflammatory conditions such as rheumatoid arthritis

· Rotator cuff tear arthropathy (arthritis associated with large rotator cuff tears)

· Family history or prior surgery to the shoulder

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How is it diagnosed?

· A physical examination will assess range of motion and strength

· X-rays confirm joint space narrowing, bone spurs, or deformity

· MRI or CT may be used to assess rotator cuff integrity or bone stock for surgical planning

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What are the treatment options?

· Early treatment includes physiotherapy, activity modification, and anti-inflammatory medication

· Cortisone injections may help reduce pain and inflammation

· Surgery is considered if symptoms are severe and not relieved by non-operative care

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When is surgery required?

· When pain and stiffness significantly limit daily life

· If conservative measures fail to control symptoms

· When X-rays show advanced arthritis or joint damage

· Surgical options depend on the condition of the rotator cuff and the pattern of arthritis

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What types of shoulder replacement are available?

Anatomical Total Shoulder Replacement (TSR):

o Used when the rotator cuff is intact

o Replaces the damaged ball (humeral head) and socket (glenoid) with artificial components that mimic the natural anatomy

o Aims to restore normal shoulder movement and reduce pain

Reverse Total Shoulder Replacement:

o Used when the rotator cuff is torn or irreparable

o Reverses the joint structure so that the ball is placed on the socket side and the socket on the arm side

o Allows the deltoid muscle to lift the arm instead of the damaged rotator cuff

o Best suited for rotator cuff tear arthropathy or complex cases

Pyrocarbon Hemiarthroplasty:

o Used in younger patients with isolated humeral head arthritis and an intact glenoid surface

o Only the humeral head (ball) is replaced with a pyrocarbon implant; the socket is left untouched

o Pyrocarbon is a smooth, durable material that mimics natural cartilage and allows low-friction movement

o Bone-preserving and avoids polyethylene wear in the glenoid, which is useful for delaying or avoiding full joint replacement

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What happens if this condition is left untreated?

· Progressive stiffness, pain, and loss of shoulder function

· Difficulty with personal care, lifting, and overhead activities

· Joint deformity and worsening quality of life

· In severe cases, the shoulder may become functionally useless

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How long is the recovery following surgery?

First 6 weeks:

o Arm is supported in a sling

o Early physiotherapy focuses on passive motion

o No lifting or pushing with the arm

6 to 12 weeks:

o Begin active movement exercises

o Gradual return of function in daily activities

o Sling is usually discontinued

3 to 6 months:

o Strengthening phase begins

o Most patients regain independence and daily function

o Ongoing physiotherapy is important

·6 to 12 months:

o Full recovery can take up to a year

o Most patients report significant pain relief and functional improvement

o Return to low-impact activities is expected; heavy lifting may be limited

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What are the expected outcomes of surgery?

· Outcomes are generally excellent, especially with appropriate rehabilitation

· Shoulder replacement reliably reduces pain and improves mobility

· Most patients return to personal care, driving, and light recreational activity. They are not designed    for heavy lifting or heavy manual work

· Some level of motion loss may persist

· Implants typically last 10–20 years depending on activity level and implant type

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What are the risks of surgery

Shoulder replacement surgery is generally safe, however does carry some level of risks as with all surgical procedures. These include:

General risks:

· Superficial infection: ~1–2%

· Bleeding/haematoma: <1% significant

· Anaesthetic risks

Specific to shoulder replacement:

· Dislocation/instability: ~1–5%

· Loosening or implant wear: ~5–10% at 10 years

· Periprosthetic fracture: ~1–3%

· Nerve injury: <1% permanent, up to 2–4% temporary neuropraxia

· Rotator cuff failure (anatomic replacements): ~2–5%

· Stiffness or persistent pain: up to 10%

Long-term risks:

· Prosthetic joint infection (late): ~1%

· Revision surgery: ~5–10% at 10 years; higher in younger, more active patients

Rare complications:

· Blood clots (DVT/PE): <1%

· Complex Regional Pain Syndrome (CRPS): <1%

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What does the rehabilitation/recovery involve?

To find out more about rehabilitation and recovery after shoulder surgery please see our Rehabilitation Protocols here.