SHOULDER ARTHRITIS OVERVIEW
Arthritis of the shoulder (the ball-and-socket joint) is an uncommon problem. In almost every case, the shoulder has been injured months or years earlier, leading to an abnormal wearing down of the cartilage. Injuries include bony fracture, dislocation, or heavy blow to the outer shoulder.
Fortunately, arthritis of the shoulder progresses slowly. Treatment focuses on reduction of inflammation, physical therapy stretching exercises to preserve motion, shoulder muscle strengthening exercises, and avoidance of activities to prevent further wear and arthritic flare-ups.
SHOULDER ARTHRITIS TREATMENT
Limit activities — Avoiding painful activities in general will alleviate strain on the injured area. Restrict lifting, overhead reaching, and reaching behind (eg, reaching into the backseat) as much as possible during the early recovery period. It is safest to keep the arm down and in front of and close to the body.
Some general rules to decrease shoulder strain with activities include:
- Lift objects close to the body.
- Only lift light weights, and limit lifting to below shoulder level.
- Do sidestroke or breaststroke when swimming (avoid the backstroke and classic crawl stroke).
- Throw balls underhand or sidearm.
- Avoid pushing exercises at the gym (eg, pushups, bench press, flies, shoulder press).
- Do not serve overhand in tennis or volleyball.
- Maintain good posture with writing, assembly work, and other tasks by keeping the shoulder blades down and back.
Pain relief — If needed, a non-prescription pain medication, such as acetaminophen (Tylenol®), ibuprofen (eg, Advil®, Motrin®), or naproxen (eg, Aleve®), can be taken. (See "Patient information: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)".) No more than 4000 mg of acetaminophen are recommended per day. Anyone who has liver disease or who drinks alcohol regularly should speak with his or her healthcare provider before taking acetaminophen.
SHOULDER ARTHRITIS STRETCHING EXERCISES
Heat — Heat helps prepare the tissues for stretching and should be performed prior to exercise sessions. The preferable method of heating is whole-body, deep heating in a warm shower or bath for 10 to 15 minutes. Local heat (for example, with a moist heating pad or a towel warmed in a microwave) is an alternative but, generally, is not as effective.
Weighted pendulum stretching exercise — These exercises are intended to help maintain joint mobility and flexibility of the muscles and tendons in the shoulder. Range of motion and flexibility exercises should not cause more than a mild level of pain; patients who feel sharp or tearing pain while stretching should stop exercising immediately and should consult their healthcare provider.
This exercise should be performed once or twice per day, after the shoulder is warmed with whole-body deep heating, cardiovascular exercise, or a directly applied warm pack.
The exercise is performed as follows (figure 1):
- Relax your shoulder muscles.
- While standing or sitting, keep your arm vertical and close to your body (bending over too far may pinch the rotator cuff tendons).
- Allow your arm to swing forward to back, then side to side, and then in small circles in each direction (no greater than one foot in any direction). Only minimal pain should be felt.
- Stretch the arm only (without added weight) for three to seven days. Progress this exercise by adding 1 to 2 lbs (0.5 to 1 kg) per week and by gradually increasing the diameter of the movements (not to exceed 18 to 24 inches or 45 to 60 cm).
- After a few weeks, this exercise should be supplemented or replaced by other exercises to target specific areas of tightness or restriction. The pendulum stretch may be recommended as a warm-up for more localized flexibility exercises and/or strengthening exercises.
When performed correctly, the pendulum exercise should not result in more than mild discomfort. If more pain is felt, consult a healthcare provider for instructions.
Passive stretching exercises — Passive stretches are performed after the pendulum stretch exercise (picture 1A-C). These exercises, performed once or twice a day for several months, should further loosen the tightened shoulder lining and should help to restore more normal range of motion. Sets of 10 to 20 of the following three exercises are performed daily:
- Armpit stretch — Use your good arm to lift the affected arm onto a shelf, dresser, or any object about breast high. Gently bend at the knees, opening up the arm pit. Try to push the arm up a little farther with each stretch.
- Finger walk — Face a wall about three-quarters of an arm’s length away. Using only your fingers (not your shoulder muscles) raise your arm up to shoulder level.
- Towel stretch — Take a three-foot-long towel, grasp it with both hands, and hold it at a 45 degree angle. Use the upper, good arm to pull the arm toward the lower back. This can be repeated with the towel in the horizontal position.
The goal of these exercises is to stretch the shoulder to the point of tension but not pain.
Muscle-toning exercises should be performed after your initial pain has resolved. These exercises are necessary to restore any lost muscle strength.
The joint should always be heated and stretched (as outline above) prior to beginning toning exercises. Following a two- or three-minute rest, perform sets of 15 to 20 exercises daily, each held for five seconds. Flexible rubber tubing, bungee cords, or large rubber bands are used for each exercise (figure 2).
Outward rotation exercise — Hold your elbows at 90 degrees, close to your sides. Grasp the rubber band with your hands, and rotate your forearms outward only two or three inches, holding for five seconds (picture 2).
Inward rotation exercise — Hold your elbow at 90 degrees, close to your side. Hook the rubber band onto a door handle, and grasp with only one hand. Rotate your forearm inward two or three inches, and hold for five seconds. The forearm swings like a door (picture 3).
Lifting exercise — Bend your elbow to 90 degrees. Place the rubber band near the elbows, and lift your arms up four or five inches away from the body, holding for five seconds (picture 4).
Mild soreness should be expected with these exercises. Sharp or severe pain may indicate a flare of the underlying problem; stop these exercises for a few days if this occurs.
WHERE TO GET MORE INFORMATION
Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient information: Osteoarthritis (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient information: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
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Evaluation of the patient with shoulder complaints
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