What is Shoulder Arthritis & When Is The Time to Discuss Shoulder Replacement?
Shoulder arthritis rarely announces itself. It arrives as a deep ache after yard work, a grinding when you reach into a high cabinet, and eventually a night where no position feels comfortable.
What it Shoulder Arthritis?
The shoulder is a ball and socket, and both surfaces are lined with smooth cartilage. Arthritis is the gradual loss of that lining. As it thins, the bones sit closer together, spurs form, and the joint becomes both painful and stiff.
Common signs are a deep ache inside the joint, pain at night lying on that side, difficulty reaching behind your back, and a slowly shrinking list of things you do comfortably.
Plain x-rays usually make the diagnosis. A CT or MRI is added only when it will change the plan, often to check the condition of the rotator cuff.
What helps before surgery?
Activity adjustments, physical therapy built specifically for an arthritic shoulder, anti-inflammatory medication when appropriate, and a cortisone injection can all buy real comfort, sometimes for years. None of them rebuild cartilage, so the goal is function and relief for as long as they hold.
When it is time to talk about replacement?
We do not replace an x-ray.
Some shoulders look severe on film in patients who sleep fine and golf every week. Those patients do not need surgery. The signs that it is worth a conversation are these:
Night pain that is costing you sleep, consistently, over months
Injections that used to last six months now lasting six weeks
Things you have given up that actually matter to you
Stiffness limiting daily life, not just sport
None of that is about age. It is about what the shoulder is costing you.
The two operations:
An anatomic replacement resurfaces the ball and socket in their normal arrangement. A reverse replacement switches their positions so the deltoid does the work the rotator cuff cannot.
Traditionally the reverse was reserved for shoulders with a torn cuff. That has been changing. Recent reviews comparing the two in patients with arthritis and an intact cuff have found reverse replacements tend to need fewer reoperations, while anatomic replacements tend to give somewhat better rotation. Both relieve pain well. The right choice depends on your cuff, the shape of your socket, and what you want to get back to, which is a conversation worth having rather than a rule.
Recovery follows a similar path either way. A sling for several weeks, therapy that starts gently, and steady gains over several months. Most people notice the night pain settle first.
Where to start
Bring any x-rays you have, and bring an honest list of what you have stopped doing. That list tells me more than the imaging does.
If your shoulder has been aching at night, I would be glad to take a look.
Dr. Eskew performs both anatomic and reverse shoulder replacement, and uses three-dimensional preoperative planning with robotic technology and intraoperative navigation to position each implant precisely for the shape of your shoulder. Because no two sockets wear the same way, that planning is part of how the right operation gets matched to the right patient.
Bring any x-rays you have, and bring an honest list of what you have stopped doing. That list tells me more than the imaging does.
If your shoulder has been aching at night, I would be glad to take a look.
