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Shoulder Osteoarthritis

Information about Shoulder Osteoarthritis

What Is Shoulder Osteoarthritis?

The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone) and the clavicle (collarbone). The part of the scapula that makes up the socket of the shoulder joint is called the glenoid. The ball and socket joint where the glenoid (scapula) and the humerus is the shoulder (Glenohumeral) joint. There is another small joint just above the shoulder called the acromioclavicular joint. This is where your collar bone meets the shoulder blade. Osteoarthritis can affect either of these joints.

When a joint develops osteoarthritis some of the cartilage covering the joint surfaces can gradually roughen and become thin. The bone underneath the cartilage then reacts by growing thicker and becoming broader, which can result in pain, swelling and restricted joint movement.

Most of the time there is no obvious reason for arthritis. It can develop as part of the natural ageing process, due to an injury, underlying inflammatory joint disease such as rheumatoid arthritis or a shoulder tendon problem (rotator cuff).  People with underlying neurological problems may also be affected.

What are the symptoms?

The main symptoms of osteoarthritis in the shoulder are pain and stiffness around the shoulder joint and upper arm.

  • Pain may be worse when you move the joint or towards the end of the day.
  • You may find your joints become stiff if you have been sitting for a while or in the morning after sleep. This often improves quickly when you get up and start moving.
  • Having stiffness in the shoulder may lead to less movement which can affect your normal daily activities. You may notice some grating or crackling sounds when you move. This is known as crepitus.

These symptoms can vary depending on what activities/ tasks you’ve been doing and how long you’ve been doing them. Symptoms can also vary for no obvious reason and you may find you have phases of pain that last a few weeks or months and other periods of time where they is very little or no pain.

How Common is Shoulder Osteoarthritis?

Osteoarthritis is not common under the age of 50. It can affect any joint but is more likely in weight-bearing joints such as the hip or knee. The shoulder is the third most common large joint to be affected by osteoarthritis.

What causes shoulder Osteoarthritis?

There are various reasons that could cause someone to develop shoulder osteoarthritis. These can include:

  • Age: After the age of 60 we are more likely to develop natural ageing of our joints
  • Gender: Osteoarthritis, in general, is more common in females
  • History of injury: Any previous shoulder dislocations or fractures (Broken bone) near the joint
  • Occupation: Those who have had more physically demanding jobs such as those working in construction
  • Sport: Those who have participated in overhead or repetitive sports, such as tennis may also be more likely to develop wear and tear

We don’t always know why certain people develop osteoarthritis. Our understanding of it and research in this area is continually developing.

Another factor that may have an impact on your symptoms is the weather. Often changes in weather for example damp, wet weather may increase your joint pain.

What can help with shoulder Osteoarthritis?

 Osteoarthritis can develop over time in the shoulder however you may not have any symptoms.  There is no cure for osteoarthritis. It is a long term condition but that doesn’t mean nothing can be done to help with the symptoms.

X-rays aren’t routinely used to diagnose osteoarthritis. As we get older we expect to see age related changes on x-ray, but these changes may not relate to your level of pain.

Exercise

While you may be worried about exercising and making your shoulder osteoarthritis worse, it is important to keep the joint moving. Too much rest can lead to stiffness. Exercise will also help to keep the muscles around the shoulder in good working order and provide the shoulder with support.

The exercises below are what we would suggest trying initially.

Pain Activity Ladder

By following the pain activity ladder you can identify activities that you would consider severely painful, moderately painful and mildly irritating and act to change your habits.

The pain scale, most often used in healthcare, measures pain from 0-10 (zero being no pain and 10 representing the worst pain you could imagine).

If you can identify the level of pain you are experiencing, you will find out if you are in the green, amber or red zone. The best way to move down to the green zone is by pacing and spacing your activity.

When you are completing your rehabilitation exercises it is often best to work within the green (and sometimes amber zones depending on what you deem is an acceptable level of pain) both during the exercises and within 48 hours of completing your exercises. If you find yourself in the red zone you are likely pushing yourself too hard and may flare up the pain.

Pacing and Spacing

Pacing and spacing methods can help you manage your pain better.

Pacing is the term used for breaking down an activity or task. This can be done by taking regular breaks. Prioritising daily activities can also help. This can prevent “over stimulating” your pain system.

When completing challenging tasks or activities, it may be useful to set a “baseline”. This is the amount you can manage on a good or bad day without increasing your symptoms. Therefore, you can plan rests and set achievable goals.

Lifestyle Adaptations

With any ongoing conditions, you may need to make some changes to your regular activities to make life easier. Here are some suggestions:

Washing and Dressing

Non-slip bat mats, rails, bath boards or seats may make getting washed easier. If you struggle to get on and off the toilet a raised toilet seat or grab rail may be of use. Consider the layout of your toiletries and avoid having to stretch to reach items.

When drying hair you could try supporting your arm on a table if you are bothered with overhead activity and struggle to hold the weight of the hairdryer.

Getting dressed is easier in a seated position. There are various tools on the market that may help with dressing for example a long-handled shoe horn.

In the Kitchen

Try to keep items that you use regularly within easy reach. Consider sitting to prepare food, a perching stool or your kitchen table may be helpful.

Try not to overfill pots or kettles as this will make them heavier to lift. It’s worth considering alternate appliances if you continue to struggle, for example, a kettle tipper or a two-handled saucepan.

If you are having difficulty using cutlery or utensils, you could try making them easier to grip by adding extra padding. You can also buy specialist cutlery with large handles.      

Sleep and Posture

If you have one side that is painful try to avoid sleeping on the affected side especially with neck, shoulder or hip pain. You might find it helpful to use extra pillows to support your arms or legs.

If sitting try not to spend too long in one position. We recommend moving every 20 minutes. Consider the height of your chair and sit in a higher chair if you struggle to get up from sitting. Armchairs may be better than a sofa as you will have arm support.

Housework and Garden

Try not to attempt too many tasks in one day.  Avoid spending too long doing repetitive activities such as cleaning windows and hoovering. You could try sitting down to iron.  

In the garden try to vary the jobs so you don’t spend too long in one position.    

Shopping and Driving

Consider using a trolley rather than a basket even if you are only needing a few items as this will give you more support and avoid you having to carry heavy objects.

Try to break up longer journeys, get out and stretch your legs regularly.

Please see the below links for further information.

When To Speak To A Health Professional

 It is important to seek medical help in certain situations: 

  • If you are in extreme levels of pain
  • If you have had a traumatic incident such as a fall, which results in you being unable to move your arm at all
  • If you have any pins and needles or numbness in your arm
  • If the skin over your shoulder is hot, red or swollen
  • If you feel feverish, unwell or have unusual levels of tiredness
  • If you have been experiencing unexplained weight loss or night-time sweating

Help And Support

If after following the above advice, your symptoms have not improved within 6 to 12 weeks, a referral to a physiotherapist may be beneficial.

You can access physiotherapy by any of the following:

Additional information

Acute Injury Management

POLICE is an acronym (Protection, Optimal Loading, Ice, Compression and Elevation) that is used as a management strategy for many injuries and conditions for the first 24 to 72 hours.

  • Protection and relative rest are advised immediately after injury for the first 24 to 72 hours.
  • Optimal Loading refers to having a balanced rehabilitation program which encourages early and gradual activity to improve recovery. How you progress will vary from person to person depending on the injury. It is about finding the injured areas happy place and increasing slowly and gradually.
  • Ice may be used for reducing pain and swelling. There are safety points to follow when you use ice:
    • Don't ice over a numb area or open wound. If the skin is numb you won't notice if you're developing an ice burn and ice on an open wound can increase the risk of infection.
    • Be wary of ice burns – don't apply ice directly to the skin, wrap an ice pack in a clean, damp tea towel before applying. Avoid prolonged exposure to ice, 10-20 minutes is usually adequate.
    • Apply crushed ice/frozen peas wrapped in a damp towel for 10-20 minutes, 2-3 times per day for the first 5-7 days post injury/ flare up of pain.
    • Stop applying ice if there are any negative effects such as increase in pain or swelling or skin soreness.
  • Compression and Elevation are helpful for reducing inflammation. This can be done by keeping your joint raised on a pillow and compressed by wrapping a bandage around it.
    Do not make the bandage too tight and do not wear tubi-grip or any compression bandage in bed at night.
  • Heat: After 2-3 days, you may find that heat is more relaxing.

You could use a heat pad or a hot water bottle with an insulated cover on it. Make sure this is not too hot and is not directly touching your skin.

You should do this for 10 to 15 minutes, 3 to 4 times a day.

What do I do if my symptoms flare up?

Flare ups of pain are common. Some people have recurrent flare ups of pain so it is important to know how best to manage these flare ups. In most cases a pain flare-up will settle within 6 weeks.

Top Tips

  • You will likely find it helpful to rest a bit more but it is still important to keep active. This will help to avoid becoming stiff and your muscles becoming weak.
  • If you aim to get a balance between rest and activity it should help your pain to settle down. You may be sore at first, however, start slowly and gradually increase the amount you do.
  • Reduce movements or tasks that aggravate your symptoms. This can help especially in the early days.
  • Adopting positions or movements that reduce your pain can be useful.

Pain Relief

Analgesia

  • Analgesia also known as pain relief can be an important part in helping you manage your symptoms and allow you to stay active.
  • Taking suitable pain relief regularly allows you to move more normally and continue your usual activities without causing any damage. It is unlikely that medication alone will resolve your pain totally. For this reason we are using the term pain relief (A 30-50% reduction in pain would be deemed to be a good success).

Paracetamol

  • Paracetamol is a good general pain management medication. It is used to help manage lots of different types of pain.
  • Sometimes people believe they need something ‘stronger’ than paracetamol when in fact, taking a regular dose rather than a one-off dose is more effective.
  • Spreading the doses of the paracetamol evenly out over a day will help you control your pain. Visit NHS Inform for more detailed information on paracetamol.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

  • NSAIDs are medications that can reduce swelling around joints and nerve endings to give pain relief. They are particularly useful
    in treating inflammatory type pain. Two commonly prescribed NSAIDs are ibuprofen and naproxen.
  • Although NSAIDs can be very useful they are not suitable for everyone. Visit NHS inform for further information related to NSAIDs.

There are other forms of pain relievers available. If you feel your current pain relievers are not helping your pain or you are
experiencing any side effects from your medication, please seek advice from your GP or pharmacist.

For general information on medication visit NHS Inform.

Staying in work and returning to work

We know that staying in work or returning to work as soon as possible is good for your mental and physical health.

If you have problems with activities at work, it may be helpful to ask for a workstation/workplace assessment or talk with your manager or Occupational Health Department. This can help with alterations or provision of equipment or altering your working day or tasks.

There are organisations which can support you at work or help you return to work. You can visit Knowledge Scotland for further information.

Weight Management

Weight Reduction – People who are overweight tend to have more prolonged pain and poorer tissue healing due to increased levels of inflammation in the body. Reducing your weight can generally help improve the healing process.

A good indicator of whether you need to lose weight is your body mass index (BMI), which you can calculate with the NHS BMI calculator.

If your BMI states you are overweight or obese it is likely that losing weight will reduce your symptoms. Carrying extra fat also increases your risk of heart disease, stroke, type 2 diabetes, and some cancers. Reducing your portion sizes and eating a balanced diet can be helpful in reducing weight. NHS informs provides a free online 12-week weight management programme to get you started right away.

If you need a little more help and feel that you would benefit from working with others in group sessions NHS Lanarkshire’s Weigh to Go programme, groups in North and South Lanarkshire, will help you become more active, eat well and lead a healthier lifestyle.

Smoking

Smoking can affect how your body recovers from musculoskeletal problems. If you smoke then the good news is that by stopping smoking it can improve your health in many different ways. Giving up smoking is not something you have to do on your own. You’re twice as likely to stop smoking successfully if you get the right support from the NHS. There is a free NHS stop smoking service available in Lanarkshire to help you succeed.

Chronic Pain

Some people will have pain which persists beyond the expected time frame for their condition. For further information on this and how best to manage it please visit our Chronic Pain webpage.

Pain Association Scotland is a national charity that delivers professionally led self-management pain education in the community.

Active Health Programme

South Lanarkshire

Active Health is a programme for residents of South Lanarkshire living with long term conditions. Residents are referred via Acute, Physio & specialist nurses to a 10-week programme and then signposted onto a wide variety of mainstream physical activity, sport & outdoor opportunities.

South Lanarkshire Leisure and Culture have many active community opportunities as well as specialised referral programmes. Full details of the 20 leisure centres can be found on the SLL website. Contact details across South Lanarkshire or call 01698 476262 to find out the number of your local leisure centre.

Please contact your health professional to discuss this referral or contact SLLC on 01698 476262.

Contact details

North Lanarkshire

North Lanarkshire Leisure’s Active Health Programme in partnership with NHS Lanarkshire provides a range of supported programmes to help individuals realise the benefits of becoming more physically active whilst also assisting those who are recovering from minor or even more serious illness.

The Active Health Programme has both a General Programme where individuals can access the mainstream health and fitness programmes running within NL Leisure Venues including swimming, jogging, golf and more!

A Specialised Health Class Programme which requires a referral from a health professional, this option is available to individuals who require additional specialised support in taking part in physical activity and classes include Strength and Balance, Cardio I, Cardio II, Back Care and Macmillan Move More classes.

A health and social care professional can make a referral by using the Active Health referral form found at the bottom of the page in the link below.

Contact Details - Health & Wellbeing Information

Mental Wellbeing

It is very important to look after your own mental wellbeing. This can have an influence on your recovery or management of your Musculoskeletal problem. Visit our mental wellbeing page for more information.

Your Feedback – comments, concerns and complaints

NHS Lanarkshire is committed to improving the service it provides to patients and their families. We therefore want to hear from you about your experience. If you would like to tell us about this please visit our feedback page.

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