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If your shoulder aches when you reach overhead, sleep on your side, or lift a bag of groceries, shoulder arthritis may be the reason. It means the smooth cartilage that caps the bones inside the joint has worn down, so the surfaces no longer glide the way they should. After more than twenty years treating arthritis of the major joints, I can tell you the pattern is familiar: a slow ache that turns into stiffness, then trouble with everyday reach. The good news is that most people manage it well, often without surgery.
My own practice in Franklin focuses on hip and knee replacement, including anterior approach hip replacement, the muscle-sparing subvastus knee technique, and Mako® robotic-assisted surgery. The way arthritis damages a joint follows the same rules wherever it happens, so I walk patients through these principles often. When a shoulder needs surgical care, I work alongside the fellowship-trained shoulder specialists at the Bone and Joint Institute of Tennessee.
What is shoulder arthritis?
Shoulder arthritis is damage to the cartilage inside the shoulder joint. Cartilage is the firm, slick tissue that covers the ends of bones; it is only two to three millimetres thick, about the thickness of a couple of layers of cardboard. When it is healthy, the joint turns smoothly and quietly. When it wears, the bone underneath gets stressed and the joint becomes painful and stiff.
The shoulder has two joints that can be affected. Most people mean the large ball-and-socket joint, called the glenohumeral joint, where the top of the arm bone meets the shoulder blade. The smaller joint on top of the shoulder, where the collarbone meets the shoulder blade, is the acromioclavicular (AC) joint, and it can wear too.
What happens to the cartilage over time?
Shoulder osteoarthritis usually develops in stages. First the cartilage softens, then it cracks, then it frays and flakes, and finally it can wear through to bare bone. People often call the late stage “bone on bone,” but arthritis is the whole process that leads there, not just the final picture.
Here is what I tell my patients: the cartilage does not wear evenly. It thins faster in some spots than others, which is why your pain may show up with certain motions and not others. As the joint changes, the body can form bone spurs (extra bony growth) that block motion.
What are the symptoms of shoulder arthritis?
The main symptom of shoulder arthritis is pain that gets worse with activity and slowly worsens over months to years. The ache often feels deep in the joint, toward the side or back of the shoulder, and many people notice it more with lifting, reaching, or carrying.
Common signs include:
- Pain in the shoulder, sometimes at rest and often worse at night, which can make sleep difficult.
- Stiffness and lost motion, so reaching a high shelf, fastening a seatbelt, or brushing your hair gets harder.
- Grinding, clicking, or catching (called crepitus) as the rough surfaces rub. It may be loud enough for others to hear.
- Weakness or a sense that the joint is not moving the way it used to.
What does shoulder arthritis feel like day to day?
Most patients describe a deep, dull ache that flares with use and eases with rest, at least early on. As the arthritis advances, the pain can linger even when the arm is still, and weather changes sometimes make it worse. Symptom severity does not always match what shows up on an X-ray; some people have mild images and real pain, and others the reverse.
What causes shoulder arthritis?
Arthritis in the shoulder has several causes, and the type matters for treatment. The main forms are:
- Osteoarthritis: the wear-related type tied to aging. It usually affects people over 50 and is the most common form.
- Rheumatoid and other inflammatory arthritis: an autoimmune condition where the body attacks its own joint lining. It often affects both shoulders.
- Post-traumatic arthritis: arthritis that follows an old fracture or dislocation of the shoulder.
- Rotator cuff tear arthropathy: arthritis that develops after a large, long-standing rotator cuff tear lets the arm bone ride up and rub against bone above it.
- Avascular necrosis: loss of blood supply to the ball of the joint, which causes the bone to collapse and the cartilage to fail.
Glenohumeral osteoarthritis, the wear-and-tear form in the main shoulder joint, is estimated to affect roughly 15 to 20 percent of middle-aged and older adults. Things that raise the odds include older age, prior shoulder injury, rotator cuff problems, a higher body weight, smoking, and a family history.
How is shoulder arthritis diagnosed?
Shoulder arthritis is diagnosed with a focused exam and an X-ray. In clinic, your surgeon checks how far the shoulder moves on its own and with help, looks for tenderness and muscle weakness, and feels for the grinding that points to worn cartilage.
An X-ray confirms the picture by showing a narrowed joint space, changes in the bone, and bone spurs. If more detail is needed, a CT scan maps the bone for surgical planning, and an MRI shows the rotator cuff and soft tissues. Sometimes a numbing injection into the joint helps confirm that the arthritis is the true pain source.
How is shoulder arthritis treated?
Treatment for shoulder arthritis almost always starts without surgery, and most people get real relief from simple measures. There is no way to regrow lost cartilage, so the goal is to control pain, protect motion, and keep you active.
Nonsurgical treatment for shoulder arthritis
In my experience, the first steps are the ones patients can do at home, and they work more often than people expect. I usually start here:
- Activity changes: let pain be your guide, and ease up on the moves that flare the joint rather than quitting everything you enjoy.
- Gentle range-of-motion stretching: a few minutes most days helps keep the shoulder loose; physical therapy helps if you are losing motion.
- Ice or heat: ice calms a sore, swollen joint (20 to 30 minutes at a time), and heat warms the shoulder before stretching. Use whichever helps you more.
- Medication: acetaminophen or anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can ease pain. Talk with your doctor first if you have stomach, kidney, heart, or bleeding concerns.
- Injections: a cortisone shot can quiet a painful flare, though relief is often temporary.
One practical point I stress: if shoulder replacement is on the table down the road, it is wise to space cortisone shots well before surgery, because an injection too close to a joint replacement can raise infection risk. Your surgeon will help you time this.
When is surgery considered for shoulder arthritis?
Surgery is considered when pain limits your life and nonsurgical care no longer helps. Because shoulder surgery is handled by my shoulder-specialist colleagues, I make sure patients understand the options before any referral. They generally include:
- Arthroscopic clean-out (debridement): a small-camera procedure that can ease pain in milder arthritis, though relief is often temporary.
- Total shoulder replacement: the ball and socket are replaced with implants; it is the standard choice for bone-on-bone arthritis with an intact rotator cuff.
- Reverse total shoulder replacement: the ball and socket positions are switched, which works better when the rotator cuff is badly torn.
Shoulder replacement is reliable at reducing pain and restoring motion, and modern implants last many years. The right operation depends on your age, your cartilage, and the health of your rotator cuff.
Can shoulder arthritis be prevented?
You cannot fully prevent arthritis in the shoulder, but you can lower your risk and slow its progress. Most of the steps are simple, and they help your whole body, not just the joint.
- Protect the joint from injury. Old fractures and dislocations are a known cause, so treat shoulder injuries early and well.
- Keep a healthy weight. Extra weight adds stress and raises inflammation throughout the body.
- Stay active with low-impact movement. Steady, gentle motion keeps the joint nourished and the muscles strong.
- Avoid nicotine. Smoking and vaping are linked to faster joint wear and slower healing.
If you already have symptoms, an early visit pays off. Caught sooner, the condition is easier to manage, and you have more time to adjust activities before the joint wears further.
When should you see a shoulder specialist near Franklin or Nashville?
See a specialist when shoulder pain wakes you at night, limits daily tasks, or has not improved with rest and simple care. Catching arthritis earlier gives you more options to slow the damage and stay comfortable.
At the Bone and Joint Institute of Tennessee in Franklin, our team cares for patients across Middle Tennessee, including Nashville, Columbia, Brentwood, and Spring Hill. My focus is hip and knee replacement, and our fellowship-trained shoulder specialists handle shoulder care, so you are matched with the right expert for your joint. If you are weighing your options, an evaluation is the best place to start.
