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If you are experiencing pain or stiffness in your shoulder, help is available. While it can be useful to do your own research online, many people find it more helpful to have a consultation with one of our experienced shoulder doctors. To arrange a consultation at a convenient time for you, please contact the appointments team at your nearest hospital, who will be delighted to help.
Your shoulder is made up of three bones. These bones move over (‘articulate’) with each other to provide movement, function and stability in the shoulder joint. The bones in your shoulder are the:
- Humerus (the upper arm),
- Scapula (the shoulder blade),
- Clavicle (the collar bone).
Surprisingly, the shoulder does not contain one joint only but actually comprises four separate joints in or around it. These are the:
- Glenohumeral joint: This ‘ball and socket’ joint is formed between the ball-like head of the humerus and the ‘socket-like’ part of the shoulder blade (‘scapula’). The socket-like structure is known as the ‘glenoid cavity’, hence the name ‘glenohumeral’ joint. It is this joint that most people refer to when talking about the shoulder joint.
- Acromioclavicular (AC) joint: Formed where your clavicle (collarbone) meets the scapula (shoulder blade). The bony process on your scapula where they meet is called the acromion, giving rise to the naming of the ‘acromioclavicular’ joint.
- Sternoclavicular (SC) joint: The joint formed where the clavicle (collarbone) meets your sternum.
- Scapulothoracic joint: Formed where the scapula meets the ribs at the back of your chest.
The structure of your shoulder gives it exceptional mobility, but it also makes it an extremely complex joint. This can become an issue should something go wrong with it. All four of these joints can be affected by arthritis and a problem in any of them can cause pain and loss of mobility in your arm and shoulder.
Arthritis is a condition affecting the joints of the body. It affects people of all ages, including children. We will be looking primarily at osteoarthritis on this page, as it is the most common form of arthritis in the shoulder. There are a couple of different types of arthritis that may also affect the shoulder, including:
- Rheumatoid arthritis; caused by the immune system attacking the joints, leading to swelling, damage and sometime a change in the shape of the joint itself.
- Cuff tear arthropathy; a common form of arthritis which develops in older people in conjunction with big rotator cuff (shoulder tendon) tears. This is probably due to age, genes and/or usage.
There is currently no cure for arthritis, but your doctor will be able to give you expert advice on the best treatments currently available to help reduce your symptoms and manage any pain.
Osteoarthritis is the most common type of arthritis in the UK. It often develops very slowly, so many people don’t notice the incremental changes it is causing in their joints until it is quite advanced.
The bones in your joints all have a lining of cartilage at their ends, known as ‘articular cartilage’. In a healthy joint the articular cartilage is smooth, and this helps the bones in the joint to move against one another freely. Osteoarthritis causes parts of this cartilage to thin and to change from being glassy smooth to rough and fragmented, leading to uneven surfaces and rough movement. This means that the bones may start to rub when they move over one another. Over time, this additional rubbing of uneven surfaces can cause damage to the joint, leading to pain and stiffness.
The body is usually very good at trying to repair damage, but osteoarthritis often means the damage occurs at a faster rate than the body is able to repair itself. Sometimes the healing process itself can cause changes in the joint which then lead to additional symptoms in the joint. One of these changes is the formation of new bony growths in the joint. Called ‘osteophytes’, these are hard lumps of bone in a joint.
The exact symptoms you experience will vary depending on the type of arthritis you have and how advanced it is. The symptoms listed below are intended for guidance. If you have any of these symptoms you should see a specialist shoulder doctor who will be able to help give you an accurate diagnosis.
- Pain: Most people first become aware of a problem in their shoulder when they have pain in it. While we all experience occasional aches, pains and twinges, you may start to notice that you only get pain in your shoulder when you move your arm or shoulder in a certain way or when you do certain activities. If your shoulder pain is being caused by arthritis you may also sometimes feel pain in your arm. Night pain in particular is a common problem.
- Reduced movement: You may notice that you are finding certain movements of your arm and shoulder more difficult. While this may not be a problem at first, as arthritis develops further in the joint it will start to limit and reduce your movements more. For shoulder arthritis, the most common movements people have difficulty with are reaching up around the back, when tucking in a shirt or doing up a bra for example. You may also find it becomes harder to reach above your head.
- Stiffness: You may feel increased stiffness in your arm and shoulder when moving them. Many people find this very frustrating.
- Weakness: You might be aware that you have lost some strength in your shoulder. While this often happens gradually, you may notice that it is becoming harder to carry out everyday tasks, such as lifting things; for example, putting the bags into the car or putting shopping away in cupboards. The muscles of your shoulder, upper back and upper arm may look thinner than usual, and you might occasionally feel your shoulder joint giving way.
It is important to note that these symptoms are not exclusively caused by arthritis and other illnesses, injuries and diseases can cause similar problems. However, these symptoms can often be a good indicator that something is not quite right with your shoulder, and it would be sensible to have your shoulder checked by a doctor for your peace of mind.
Ongoing national and international research into arthritis continues to improve our understanding of the disease. The specific causes of osteoarthritis remain unclear, although there are a number of factors known to increase the risk of developing it in the shoulder joint. These include:
- Genes: Primary osteoarthritis is a gene-related condition which tends to get passed down the family on the female side.
- Previous injury to the shoulder joint: A previous injury, such as a fracture or , or an operation on the shoulder joint, can increase the possibility of developing osteoarthritis in it at a later date.
- Age: While osteoarthritis can develop at any age, it is more commonly seen in people over the age of 50.
- Gender: Women are more likely to develop osteoarthritis than men. It often begins to develop after the menopause, although the exact reasons for this are not yet fully understood.
- Weight: Obesity carries with it a multitude of health issues and risks and these include a raised risk of developing osteoarthritis. Weighing more means an increased load and pressure is placed on your weight-bearing joints like the knees and hips.
While many of us may accept a degree of stiffness and mild pain in the shoulder as a natural result of growing older, long-term and/or worsening problems in the shoulder should not be ignored. You do not have to ‘suffer silently’ with a shoulder problem, as medical help is available.
In the early stages of arthritis, you may not feel the need to see a doctor. Some people say that they’re worried they will be “wasting a doctors time” when they don’t have any significant symptoms. However, it is always sensible to seek expert medical advice when you start to lose the ability to carry out certain tasks, or when the pain reaches a certain level.
If your shoulder pain is persistent, present even when you are resting, or it is waking you up at night, a consultation with a specialist shoulder doctor is recommended.
