Shoulder Arthritis: Symptoms and Treatment

Shoulder arthritis is an inflammatory and degenerative disorder of the shoulder girdle, most commonly affecting the scapulohumeral and acromioclavicular joints. In everyday practice, "arthritis" most often refers to osteoarthritis (degenerative cartilage wear) and, less commonly, inflammatory forms such as rheumatoid arthritis, post-infectious arthritis, and post-traumatic arthritis. Pain, stiffness, and limited arm function are the primary symptoms, impairing daily life, work, and sports. [1]

The shoulder joint is the most mobile large joint in the body, its stability provided by the glenoid labrum, ligament-capsular apparatus, and rotator cuff muscles. An imbalance in these structures accelerates cartilage wear and pain. Cuff tears lead to a specific type of arthropathy, characterized by elevation of the humeral head and secondary wear. [2]

The clinical picture varies: in osteoarthritis, stress pain and crepitus predominate; in inflammatory arthritis, morning stiffness and swelling; and in acromioclavicular joint involvement, localized tenderness "at the tubercle" and pain when adducting the arm across the body. Correct classification is important for therapy selection and prognosis. [3]

Modern tactics involve a multi-level approach: patient education, load and sleep modification, targeted physical therapy, pharmacotherapy with an emphasis on safety, and, if necessary, injection methods and surgical reconstruction or endoprosthetics. The choice depends on age, activity, injury anatomy, and associated medical conditions. [4]

Epidemiology

Osteoarthritis of the acromioclavicular joint is more common than osteoarthritis of the glenohumeral joint, especially after age 50. However, it is often asymptomatic and is detected incidentally on radiographs. Osteoarthritis of the glenohumeral joint, while less common, is more often responsible for clinically significant pain and limitation of function. [5]

Shoulder instability and injury in youth, heavy physical labor, and overhead sports increase the risk of earlier cartilage wear and subsequent arthritis. In older adults, chronic rotator cuff tears with subsequent arthropathy are a common cause. This explains why surgical approaches in this group often include reverse arthroplasty. [6]

The proportion of patients requiring surgery is small compared to the overall number of those suffering from shoulder pain: most benefit from a conservative program. However, with increasing life expectancy and athletic activity, the need for shoulder replacement is steadily increasing, and the long-term results of modern implants demonstrate good survival rates. [7]

In patients with systemic inflammatory diseases, such as rheumatoid arthritis, shoulder involvement is common and requires basic anti-inflammatory therapy under the supervision of a rheumatologist, and, if the joint is destroyed, reconstruction. This should be distinguished from isolated osteoarthritis based on laboratory and clinical findings. [8]

Reasons

The main causes of shoulder osteoarthritis are age-related changes in cartilage, repeated microtraumas from overhead movements, the consequences of instability, and post-traumatic deformities. Some patients have congenital or acquired weakness of the scapular stabilizers and rotator cuff, which accelerates wear. [9]

In rotator cuff arthropathy, a prolonged tear disrupts the balance of forces: the head rises, reducing the contact area and overloading the superior-lateral segments, leading to rapid cartilage wear and osteophytes. In such cases, specific indications for reverse arthroplasty are developed. [10]

The acromioclavicular joint often suffers after overloading with pressing and contact loads, repeated blows to the upper shoulder girdle, and post-traumatic changes. Here, pain is localized "on the collarbone" and intensifies when bringing the arm across the body and during push-ups. [11]

Inflammatory arthritis is caused by systemic immune mechanisms. It is often bilateral, characterized by morning stiffness lasting more than 30 minutes, elevated acute-phase reactants, and requires a different treatment regimen than that for wear-and-tear osteoarthritis. [12]

Risk factors

Age over 50 years, male gender for the acromioclavicular joint, heavy physical labor, overhead sports, and repeated episodes of instability are confirmed risk factors for wear-and-tear arthritis of the shoulder. Smoking and obesity are associated with poorer treatment outcomes.[13]

A rotator cuff tear, regardless of age, significantly increases the risk of arthropathy, especially with tendon retraction and fatty degeneration of the muscles. In individuals who have undergone shoulder surgery, the progression of arthrosis depends on the restoration of biomechanics. [14]

The acromioclavicular joint is typically overloaded by weightlifting, contact sports, and falls on the shoulder. Untreated damage to the disc and capsule leads to accelerated wear of the surface. [15]

In inflammatory arthritis, the main factors are genetic predisposition and systemic immune disorders; in addition to the shoulder, the wrists, small joints of the hands, elbows, and knees are also affected. This shifts the treatment priorities toward basic therapies, rather than just local treatment of the shoulder. [16]

Pathogenesis

Osteoarthritis destroys hyaline cartilage, reduces the thickness and uniformity of the articular surface covering, increases bone load, and osteophytes develop. The synovial membrane responds with low-intensity inflammation, causing effusion and pain. A combination of mechanical and biological factors perpetuates a vicious cycle. [17]

Misalignment of the humeral head due to rotator cuff laxity or scapular dyskinesia increases shear loads and accelerates cartilage wear. In cuff tear arthropathy, cranial displacement of the humeral head and eccentric cartilage wear predominate. This explains why soft tissue reconstruction without restoring balance does not stop the progression of arthritis. [18]

In the acromioclavicular joint, the key mechanisms are disc wear, subchondral sclerosis, and osteophytes with medial conflict when adducting the arm across the body. A diagnostic test with a local anesthetic can confirm the joint's role as the source. [19]

In inflammatory arthritis, the primary mechanism is immune-mediated synovitis, which, without basic therapy, leads to erosions and deformities. In the chronic phase, periarticular structures are also affected, complicating functional recovery even after disease activity has been controlled. [20]

Symptoms

Stress and movement trigger deep shoulder pain, especially with external rotation and abduction. Many experience nighttime pain, a popping sound, a "biting" sensation when rotating, and morning stiffness. A gradual decrease in range of motion interferes with dressing and personal care. [21]

When the acromioclavicular joint is affected, pain is localized to the collarbone and intensifies when the arm is brought across the body and when supporting weight on the arms. A diagnostic injection of local anesthetic temporarily relieves pain and confirms the diagnosis. [22]

Typical symptoms of rotator cuff tear arthropathy include weakness in arm elevation, fatigue, and pain when attempting to lift objects above shoulder level. Sleeping on the affected side can increase pain. [23]

Inflammatory arthritis is accompanied by signs of systemic inflammation: morning stiffness lasting more than 30 minutes, tenderness upon palpation, and sometimes swelling and warmth. Other joints are often affected, which aids in differential diagnosis. [24]

Forms and stages

Osteoarthritis of the scapulohumeral joint, rotator cuff arthropathy, acromioclavicular joint osteoarthritis, posttraumatic arthritis, and inflammatory arthritis are distinguished. Each has its own pain pattern, movement mechanics, and treatment priorities. [25]

The staging of osteoarthritis conventionally includes an early phase of pain without gross radiographic changes, an intermediate phase with narrowing of the joint space and osteophytes, and a late phase with severe stiffness, deformity, and rest pain. For the acromioclavicular joint, the stages are determined by the severity of osteophytes and marginal pain. [26]

In arthropathy with a cuff tear, staging takes into account the size and retraction of the tear, fatty muscle degeneration, and cranial displacement of the head. This directly influences the choice between cuff reconstruction, soft tissue stabilization, and reverse arthroplasty. [27]

Table 1. Main forms of shoulder arthritis and practical emphases

Form	Clinical clues	Research Key	Treatment priority
Osteoarthritis of the shoulder joint	Load, crepitus, night pain	X-ray, magnetic resonance imaging if necessary	Training, physical therapy, injections, arthroplasty as indicated
Cuff tear arthropathy	Weakness of ascent, fatigue	Magnetic resonance imaging, functional tests	Cuff and scapula balance, reverse arthroplasty in severe insufficiency
Osteoarthritis of the acromioclavicular joint	Local pain in the collarbone, arm-across test	Targeted X-ray, diagnostic injection	Conservatively, if resistant - resection of the distal end of the clavicle
Inflammatory arthritis	Morning stiffness, polyarthritis	Laboratory markers, ultrasound	Basic therapy by a rheumatologist plus local measures

Summary of guidelines and reviews. [28]

Complications and consequences

Without treatment, pain and limited motion progress, strength and endurance decline, and sleep is disrupted. A shift to physical inactivity worsens metabolic health and increases the risk of falls. With rotator cuff tear arthropathy, deformity and supramoleximal displacement of the rotator cuff increase. [29]

In the later stages of osteoarthritis, contractures, osteophytes, and severe subchondral sclerosis may develop. In acromioclavicular arthritis, chronic pain occurs with any weight-bearing on the arms. These conditions limit daily life and work capacity. [30]

Infectious and mechanical complications are possible after surgery, but modern protocols and implants reduce the risks; with reverse hip replacement, satisfaction and implant survival rates in the mid-term are high. [31]

Without basic therapy, inflammatory arthritis can develop erosions and deformities, reducing the potential for rehabilitation. Early escalation of basic therapy improves function and delays the need for reconstruction. [32]

Diagnostics

Diagnosis begins with a history and physical examination, assessing the pain area, range of motion, rotator cuff strength, and scapular control. The transverse arm adduction test exacerbates pain in acromioclavicular arthritis; a diagnostic injection of local anesthetic helps confirm the joint's source. [33]

Radiography in standard projections is the basic method for verifying osteophytes, narrowing of the joint space, and osteosclerosis. Computed tomography is useful in planning arthroplasty and assessing bone deficiency; magnetic resonance imaging shows cartilage, the cuff, and the bicipital complex. [34]

Ultrasound is useful for cuff assessment and injection navigation. Ultrasound navigation improves the accuracy of intra-articular injections compared to blind injection, which may impact the effectiveness and safety of the procedures. [35]

Laboratory tests are indicated if an inflammatory process is suspected: complete blood count, C-reactive protein, rheumatoid factor, and antibodies to citrullinated peptides. In the presence of fever and acute effusion, septic arthritis is excluded. [36]

Table 2. Visualization and laboratory: what, when and why

Task	Method	Clinical objective
Confirm osteoarthritis	X-ray	Osteophytes, narrowing, sclerosis
Assess soft tissues	Magnetic resonance imaging, ultrasound	Cuff, lip, biceps
Administer the medication accurately	Ultrasound-guided injection	Increased accuracy and control
To identify the inflammatory genesis	Laboratory markers	Basic therapy tactics

Summarized from clinical sources. [37]

Differential diagnosis

Rotator cuff impingement and tendinopathy cause pain on abduction and nocturnal complaints, but x-rays may be normal, and magnetic resonance imaging (MRI) may reveal tendinopathy and bursitis without a significant chondral defect. Conservative treatment differs in emphasis. [38]

Adhesive capsulitis (frozen shoulder) presents with progressive limitation of all directions of motion, accompanied by severe morning stiffness. The diagnosis is confirmed by clinical examination and exclusion of other causes; ultrasound-guided glucocorticosteroid injections and intensive mobilization are beneficial. [39]

Cervical radiculopathy and myofascial pain of the trapezius and rhomboid muscles can mimic shoulder pain but are accompanied by radiation below the elbow, paresthesias, and positive cervical spine tests. A neurological examination and cervical spine imaging are helpful when indicated. True septic arthritis requires urgent differentiation in the presence of fever and severe pain. [40]

Treatment

Non-pharmacological measures. Patient education, weight management, sleeping on the healthy side with a pillow under the forearm, and heat and cold therapy as needed. Targeted physical therapy with an emphasis on scapular control, strengthening the external rotators, and stretching the posterior inferior capsular complex are the foundation for improving function. A graduated load regimen and modified overhead technique can reduce pain. [41]

Pharmacotherapy. Topical nonsteroidal anti-inflammatory drugs and non-narcotic analgesics are the initial treatment options. Oral nonsteroidal anti-inflammatory drugs are used briefly, with gastrointestinal protection and consideration of cardiovascular risks. For inflammatory arthritis, the priority is basic therapy according to rheumatology guidelines. [42]

Injections. Intra-articular glucocorticosteroids reduce pain in the short term and can facilitate rehabilitation, especially with effusion; ultrasound guidance improves accuracy. Evidence for hyaluronic acid in shoulder osteoarthritis is limited and recommendations are inconsistent, so the decision is individualized. Data on platelet-rich plasma are mixed, with no consensus yet. [43]

Surgery. In cases of resistant pain and significant structural pathology, arthroplasty is considered. In cases of intact cuff, anatomical total arthroplasty is considered; in cases of cuff tear arthropathy, reverse arthroplasty has good medium- and long-term outcomes. In cases of isolated acromioclavicular arthritis that has not responded to conservative measures, resection of the distal clavicle is performed open or arthroscopically. [44]

Rehabilitation after injections and surgeries. Early protected mobilization, gradual restoration of range of motion, followed by a strength program with an emphasis on the scapula and cuff. Return to work and sports is based on objective criteria: pain-free range of motion, strength of at least 90 percent of the healthy side, and scapular control tests. [45]

Table 3. Conservative and invasive tactics for shoulder arthritis

Situation	First line	Escalation
Early osteoarthritis without severe ruptures	Education, physical therapy, topical nonsteroidal anti-inflammatory drugs	Ultrasound-guided glucocorticosteroid injections, short courses of systemic nonsteroidal anti-inflammatory drugs
Acromioclavicular arthritis	Limitation of provocative movements, physiotherapy, local remedies	Diagnostic and therapeutic injection; if there is no effect, resection of the distal end of the clavicle
Cuff tear arthropathy	Physiotherapy, correction of the kinetic chain	Reverse hip replacement for severe insufficiency
Inflammatory arthritis	Basic therapy with a rheumatologist	Local injections as an adjunct to synovitis

Summarized from clinical guidelines and reviews. [46]

Prevention

Primary prevention includes developing strength in the external rotators and scapular stabilizers, teaching safe overhead technique, taking breaks during monotonous work, and monitoring body weight. For athletes, periodization of loads and symptom monitoring are important to prevent tendinopathy from progressing to arthritis due to chronic overuse. [47]

Secondary prevention after an exacerbation or surgery includes a maintenance program for scapula and cuff stabilization, modification of everyday and work habits, and smoking cessation. For inflammatory arthritis, adherence to basic therapy and regular monitoring by a rheumatologist are critical. [48]

Forecast

Most patients with shoulder osteoarthritis achieve clinically significant pain relief and improved function with education, physical therapy, and the appropriate use of injections and medications. When necessary, arthroplasty provides high levels of satisfaction and implant longevity in the midterm. [49]

The prognosis is worse when arthritis is combined with massive cuff tears, severe deformity, and comorbidity. However, reverse hip arthroplasty demonstrates good long-term results in cuff tear arthropathy, allowing a return to daily activities and some sports. [50]

FAQ

• Does hyaluronic acid help with shoulder osteoarthritis?

Evidence is limited and recommendations are mixed. Decisions are made on an individual basis after discussion of expected benefits, costs, and alternatives. [51]

• Does glucocorticosteroid injection have to be performed under ultrasound guidance?

Navigation improves insertion accuracy and may improve clinical outcome and safety compared to blind insertion. Whenever possible, ultrasound guidance is preferred. [52]

• When is it time to consider joint replacement?

When pain and functional limitation persist despite an optimal conservative program and significant radiographic changes or cuff tear arthropathy develop, the choice between an anatomical and a reverse prosthesis depends on the condition of the rotator cuff. [53]

• Pain "on the collarbone" when bringing the arm across the body - is this definitely the shoulder joint?

Often this is acromioclavicular arthritis. A diagnostic injection of local anesthetic into this joint helps confirm the source of the pain. [54]

Causes arthritis of the shoulder joint

Below are some of the most common causes of shoulder arthritis:

1. Age: As we age, the cartilage that covers our joint surfaces can naturally wear and tear. This can lead to the development of osteoarthritis of the shoulder, which is one of the most common forms of arthritis.
2. Trauma: Trauma or injury to the shoulder, such as a fracture, dislocation, or strain, can trigger the development of post-traumatic arthritis.
3. Rheumatoid arthritis: Rheumatoid arthritis is a chronic inflammatory disease that can affect various joints, including the shoulder. It is caused by an autoimmune response and can damage joints over time.
4. Other forms of arthritis: There are various other forms of arthritis, such as psoriatic arthritis, gout, and ankylosing spondylitis, which can also affect the shoulder joint.
5. Infections: Sometimes shoulder arthritis can be caused by an infection, such as a bacterial or viral infection of the joint.
6. Hormonal and metabolic disorders: Certain hormonal and metabolic diseases, such as thyroid disease and diabetes, can affect the joints and trigger the development of arthritis.
7. Genetic predisposition: Genetic factors may also play a role in the development of arthritis, especially if there is a family history of the disease.

Symptoms arthritis of the shoulder joint

Here are common symptoms and signs of shoulder arthritis:

1. Pain: Pain is one of the main symptoms of shoulder arthritis. It can be sharp, dull, throbbing, or burning, and it usually gets worse with shoulder movement.
2. Limitation of motion: Patients with shoulder arthritis often experience limited range of motion in the shoulder. This may manifest as difficulty raising the arm, flexing or extending the shoulder, or rotating it.
3. Joint stiffness: Morning joint stiffness is a common symptom. Patients may experience difficulty moving in the morning or after prolonged inactivity.
4. Inflammation and swelling: Inflammation of the shoulder joint can cause swelling, redness, and warmth of the skin in the area of the joint.
5. Muscle weakness: Due to pain and limited movement, shoulder muscles may become weak and less strong.
6. Creaking and creaking sounds in the joint: Some patients may experience a crunching or creaking sound in the shoulder joint when moving.
7. Skin changes: In rare cases, shoulder arthritis can cause skin changes, such as rashes or sores.
8. Symptoms of systemic inflammation: In the case of rheumatoid arthritis, systemic arthritis, or other systemic forms of arthritis, symptoms may include fever, fatigue, and weight loss.

Stages

Shoulder arthritis, like other types of arthritis, can have varying degrees of severity, which help assess the severity of changes in the joint. Assessing the severity of shoulder arthritis can help your doctor determine the appropriate treatment plan. The generally accepted system for assessing the severity of arthritis is the ACR (American College of Rheumatology) classification, which uses four grades:

1. Grade I (minimal): This stage of arthritis involves mild joint inflammation, often without visible deformities or limited mobility. The patient may experience mild pain and discomfort, but their impact on daily life is limited.
2. Grade II (moderate): In this stage of arthritis, inflammation is more pronounced, the joint may be slightly deformed, and limited motion becomes more noticeable. Pain is more severe and may interfere with some everyday tasks.
3. Grade III (severe): The joint is significantly inflamed and deformed. Pain becomes intense, and mobility is more severely limited. This grade of arthritis can seriously limit the ability to perform everyday tasks.
4. Grade IV (extremely severe): At this stage of arthritis, the joint undergoes severe destruction and deformity. Pain is intense and constant, and mobility is almost completely lost. This condition can significantly limit the patient's life and requires serious intervention.

Classifying the severity of arthritis can help your doctor determine the best treatment, including medication, physical therapy, lifestyle changes, or surgery.

Forms

Shoulder arthritis can have various forms and subtypes, including acute and chronic, inflammatory and non-inflammatory, and various etiologies. Here is a brief description of the main types of shoulder arthritis:

1. Acute: Acute arthritis can develop suddenly and lead to inflammation of the shoulder joint. This can be caused by infection, injury, or other factors.
2. Chronic: Chronic arthritis lasts for a long time and can be caused by various conditions such as rheumatoid arthritis or osteoarthritis.
3. Rheumatoid: Rheumatoid arthritis is a systemic autoimmune disease that affects multiple joints, including the shoulder. It results in chronic inflammation, pain, and joint deformity.
4. Suppurative: Suppurative arthritis occurs when a joint becomes infected with bacteria. This condition requires immediate medical attention.
5. Psoriatic: Psoriatic arthritis is arthritis that develops in patients with psoriasis, a chronic skin condition. It can affect the shoulder and other joints.
6. Reactive: Reactive arthritis can develop after an infection in another part of the body and affect the shoulder joint, causing inflammation.
7. Post-traumatic: This type of arthritis develops after injury or damage to the shoulder joint and can manifest as chronic inflammation and degeneration of the joint.

Diagnostics arthritis of the shoulder joint

Diagnosing shoulder arthritis involves several steps that will help the doctor determine the presence, type, and severity of arthritis. Here are the main diagnostic methods for shoulder arthritis:

1. Medical history and physical examination:

   • Your doctor will begin by talking with you about your symptoms, medical history, and factors that might increase your risk of developing arthritis.
   • The physical examination includes an assessment of shoulder joint motion, looking for signs of inflammation (warmth, redness), and assessing tender points and limitations in motion.

2. X-ray of the shoulder joint:

   • X-rays can be used to evaluate the structure and condition of the joint, look for signs of osteoarthritis (wear and tear of the joint), and determine the presence of bone changes.

3. Magnetic resonance imaging (MRI):

   • An MRI can provide more detailed information about the condition of joint tissues, including cartilage, tendons, and soft tissue. This can help identify other forms of arthritis and assess the extent of inflammation.

4. Blood test:

   • Blood tests can help detect markers of inflammation, such as C-reactive protein (CRP) and serum rheumatoid factor (RF) antibody levels, which may be associated with rheumatoid arthritis.

5. Ultrasound examination (ultrasound):

   • Ultrasound can be used to evaluate the condition of the joint, including the presence of inflammation and joint effusion.

6. Joint aspiration (joint puncture):

   • If the diagnosis is unclear, a joint aspiration may be performed to collect a sample of joint fluid for analysis. This can help determine the type of arthritis and rule out infectious causes of pain.

Differential diagnosis

Differential diagnosis of shoulder arthritis involves identifying and distinguishing this condition from other possible causes of shoulder pain or inflammation. Here are some possible conditions and diagnostic methods that may be used:

1. Osteoarthritis (arthrosis): Osteoarthritis of the shoulder can mimic the symptoms of arthritis. Diagnosis may include x-rays to assess the joints and rule out signs of inflammation typical of arthritis.
2. Subacute/chronic synovitis: This is inflammation of the joint capsule (synovium) or joint membranes. Synovial fluid analysis and imaging studies (MRI or ultrasound) may be performed to evaluate the condition of the joint and synovium.
3. Traumatic injury: A shoulder injury can cause arthritis-like symptoms. X-rays and a physical examination can help determine the presence of injuries or fractures.
4. Rheumatoid arthritis: This is a chronic systemic inflammatory disease that can affect joints, including the shoulder. Diagnosis includes blood tests such as rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies, X-rays, and MRI.
5. Other types of arthritis: There are many different types of arthritis, including intra-articular arthritis, arthritis associated with other systemic diseases (e.g., systemic lupus erythematosus, ankylosing spondylitis, etc.), and others. Diagnosis may vary depending on the type of arthritis.
6. Infectious arthritis: If infectious arthritis is suspected, joint fluid tests may be done to identify germs.
7. Tendinitis: Inflammation of the tendons in the shoulder joint can mimic the symptoms of arthritis. Ultrasound or MRI can be used to evaluate the condition of the tendons.

Shoulder osteoarthritis and arthritis are two distinct medical conditions that can affect the shoulder joint. They have different causes, symptoms, and treatment approaches.

1. Shoulder arthrosis (also known as osteoarthrosis):

   • Cause: Shoulder osteoarthritis is a degenerative condition characterized by wear and tear of the articular cartilage and changes in the articular bone. This process can be related to age, increased stress on the joint, injury, or other factors.
   • Symptoms: Symptoms of shoulder osteoarthritis may include pain, a creaking or popping sound when moving the joint, limited arm raising, and decreased shoulder function. Pain typically worsens with movement and improves with rest.

2. Shoulder arthritis:

   • Cause: Shoulder arthritis is an inflammatory condition caused by various factors, such as rheumatoid arthritis, viral or bacterial infections, systemic immune system diseases, and others. Arthritis is characterized by inflammation of the joint tissues.
   • Symptoms: Symptoms of arthritis include pain, inflammation, swelling, and morning stiffness in the shoulder. Systemic symptoms such as fatigue and fever may also occur.

Treatment for shoulder arthrosis and arthritis can vary depending on the type and severity of the condition. Common treatment approaches include physical therapy, pain medications, lifestyle modifications, muscle strengthening exercises, and, in some cases, surgery.

Treatment arthritis of the shoulder joint

Treatment for shoulder arthritis may involve several stages and depends on the severity of the condition, its cause, and the patient's overall condition. Below are the general stages and protocols for treating shoulder arthritis:

1. Diagnosis: The first step is an accurate diagnosis of the disease. The doctor will conduct an examination, collect a medical history, and possibly perform tests such as X-rays, MRIs, or ultrasounds to determine the type of arthritis and the extent of joint damage.

2. Drug treatment:

   • Anti-inflammatory medications (NSAIDs): NSAIDs, such as ibuprofen, can help reduce inflammation and pain.
   • Pain relievers: Pain relievers may be needed.
   • Injections: Injections of corticosteroids or hyaluronic acid may help reduce inflammation and pain.
   • Disease-modulating medications: For rheumatoid arthritis, your doctor may prescribe disease-modulating medications (biologics).
3. Physical therapy and rehabilitation: Physical therapy can help strengthen shoulder muscles, improve joint mobility and reduce pain.
4. Lifestyle changes: It is important to lead an active and healthy lifestyle, pay attention to physical activity and proper nutrition.
5. Surgical Treatment: If conservative treatment does not provide improvement, your doctor may consider surgical options such as arthroscopy, fusion, joint revision, or shoulder replacement.
6. Maintenance therapy: Managing arthritis may require regular visits to your doctor and following joint care recommendations.

Medications for shoulder arthritis

Treatment for shoulder arthritis involves the use of various medications to reduce inflammation, relieve pain, slow disease progression, and improve quality of life. Treatment strategies depend on the type of arthritis, its severity, and the individual patient's characteristics. Below are the main groups of medications that can be used for shoulder arthritis:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs):

   • Examples: ibuprofen, diclofenac, naproxen, meloxicam and others.
   • NSAIDs help reduce inflammation and relieve pain. They can be taken as tablets, creams, gels, or injections.

2. Glucocorticosteroids (corticosteroids):

   • Examples: methylprednisolone, prednisolone.
   • Glucocorticosteroids can be injected directly into the joint to reduce inflammation and pain. This is often used in cases of severe symptoms.

3. Disease-modifying antirheumatic drugs (DMARDs):

   • Examples: methotrexate, hydroxychloroquine, sulfasalazine, and others.
   • Antiretroviral drugs are used to manage systemic forms of rheumatic diseases, such as rheumatoid arthritis. They can slow disease progression and reduce inflammation.

4. Biological drugs:

   • Examples: adalizumab, infliximab, etanercept and others.
   • Biologic drugs are used to treat severe symptoms of arthritis and rheumatic diseases. They block certain inflammatory proteins, reducing inflammation and slowing joint damage.

5. Analgesics and muscle relaxants:

   • Examples: paracetamol, codeine, tricyclic antidepressants, etc.
   • These medications can be used to reduce pain and relieve muscle spasms that may accompany arthritis.

6. Additional funds:

   • Vitamins and minerals such as vitamin D and calcium may be recommended to support joint health.
   • Physical therapy, exercise, relaxation, and lifestyle changes can also be important parts of treatment.

Ointments for arthritis of the shoulder joint

For shoulder arthritis, various ointments and creams can be used to relieve pain, reduce inflammation, and improve joint mobility. Your doctor may recommend a specific treatment based on your diagnosis and symptoms. Below are some possible ointments and creams that may be used:

1. NSAIDs (non-steroidal anti-inflammatory drugs):

   • Diclofenac (Voltaren, Diclofenac)
   • Ibuprofen (Advil)
   • Naproxen (Aleve)

2. Glucocorticosteroid ointments:

   • Hydrocortisone
   • Prednisolone
   • Desoxymethasone (Topicort)

3. Ointments with salicylates:

   • Methyl salicylate (Bengay, Icy Hot)
   • Menthol (Biofreeze, Flexall)

4. Ointments with camphor and menthol:

   • Vikasol (Camphor-Phenol, Thera-Gesic)
   • Emersol (Salonpas)

5. Ointments with capsaicin:

   • Capsaicin (Capsaicin, Zostrix)

6. Ointments with chondroitin and glucosamine:

   • Chondroitin and glucosamine can be used for joints, including the shoulder. Examples include ArthriFlex, FlexaJoint, and others.

7. Gels with arnica and herbal ingredients:

   • Some natural gels may contain arnica, boswellia, angelica, and other herbal ingredients that can help relieve pain and inflammation.

8. Ointments with anesthetics:

   • Ointments containing anesthetics can provide temporary pain relief. Examples include lidocaine and benzocaine ointments.

Exercises for Shoulder Arthritis

They can help improve joint mobility, strengthen muscles, and relieve pain. However, before starting any exercise program, it's important to consult with a doctor or physical therapist to ensure they are appropriate for your condition and won't cause further harm. Here are some exercises that may be helpful for shoulder arthritis:

1. Passive exercises to improve mobility:

   • While sitting or standing, use your healthy arm to help raise and lower your larger, sore arm to improve shoulder mobility. Gradually increase the range of motion.
   • Gentle circular movements of the sore arm back and forth can help relieve joint stiffness.

2. Stretching exercises:

   • Continuously stretch your shoulder by straightening your arm and gently pulling it downward. Hold this position for a few seconds, then return to the starting position. Repeat several times.
   • Shoulder stretch across the body: Cross your large arm in front of your chest and gently pull it with your other arm. Hold the stretch for 20-30 seconds and repeat on the other side.

3. Strengthening the shoulder muscles:

   • Light resistance band exercises can help strengthen your shoulder muscles. For example, you can attach a band to a doorknob and perform arm raises and arm curls with light resistance.
   • Exercises with dumbbells or bodyweight can also help strengthen muscles. For example, lift a dumbbell up in front of you and lower it with control.

4. Active exercises to maintain mobility:

   • Rotating your arm at the shoulder joint can help maintain mobility. Make sure the movements are gentle and controlled.

5. Exercises to strengthen the back and neck muscles:

   • Strengthening your back and neck muscles can help maintain proper posture and reduce stress on your shoulders.

Folk remedies

Folk remedies can be used as a complement to traditional medical treatment to relieve the symptoms of shoulder arthritis. However, it's important to remember that they are not a substitute for professional medical treatment and consultation with a doctor. Before using folk remedies, it's recommended to consult a doctor to ensure they are safe and don't interact with other medications or treatments. Here are some folk remedies that may help:

1. Mustard wrap: Mix mustard powder with water to form a thick paste, which can be applied to the sore shoulder. Leave the wrap on for several minutes (being careful not to burn) and then rinse off. This can help improve circulation and relieve pain.
2. Baking soda compresses: Baking soda can be used to create a compress. Dissolve 2-3 teaspoons of baking soda in 1 liter of warm water and soak a gauze pad in the solution. Apply to the shoulder for several minutes.
3. Lavender Oil Massage: A gentle shoulder massage using lavender oil can help relax muscles and improve circulation.
4. Warm compresses: Applying warm compresses to the affected area can help improve blood flow and relieve pain. Use a heating pad filled with warm water or a heating pad filled with salt.
5. Uses of Camphor Oil: Camphor oil can be massaged into the shoulder area to relieve pain and reduce inflammation.
6. Golden Hammer (Turmeric): Turmeric is a spice that contains curcumin, has anti-inflammatory properties, and may help reduce arthritis symptoms. It can be added to food or taken as a capsule (after consulting with a doctor).
7. Green Tea: Green tea is rich in antioxidants, which can help reduce inflammation and relieve pain.
8. Vitamin D and Calcium: Vitamin D and calcium play an important role in maintaining bone and joint health. Consider adding these vitamins to your diet if your levels are low.

Literature

• Kotelnikov, G.P. Traumatology / ed. Kotelnikova G. P., Mironova S. P. - Moscow: GEOTAR-Media, 2018.
• Pavel Evdokimenko: Arthritis. Getting Rid of Joint Pain, Peace and Education, 2017
• Frank Green / Shoulder Joint Treatment: Exercises and Medications, 2020