Shoulder Arthritis Surgical Treatment

Nonoperative treatment is the first step for nearly every patient, and it is particularly appropriate for patients who have:

• Early or moderate arthritis: Pain and stiffness that have not yet meaningfully restricted daily life.
• Preserved function: Patients who can still perform the activities that matter to them, even with discomfort.
• Younger patients: Because implants have a finite lifespan, delaying replacement in a patient in their forties or fifties may avoid a revision later.

The goal of nonoperative treatment is to control pain, preserve the motion that remains, and keep the surrounding muscles strong, all of which also make for a smoother recovery if a replacement is eventually needed.

• Activity modification: Adjusting how tasks are performed, rather than avoiding activity altogether, is often the single most effective change. Keeping the arm closer to the body, avoiding repetitive overhead reaching, and distributing lifting between both arms reduce the load across a worn joint.
• Physical therapy: A program aimed at maintaining range of motion, particularly outward rotation, and strengthening the rotator cuff and the muscles that control the shoulder blade. Therapy for arthritis is gentler than therapy after an injury, and pushing aggressively into painful ranges tends to make an arthritic shoulder more irritable rather than looser.
• Home program: Daily gentle motion, often with a stick or pulley, prevents the gradual stiffening that makes arthritis progressively more disabling.
• Anti-inflammatory medication: Oral anti-inflammatories can reduce pain enough to allow therapy and normal activity, and topical formulations are an option for patients who cannot take them by mouth.
• Corticosteroid injection: An injection into the joint can provide meaningful relief lasting weeks to months and is often what allows a patient to participate fully in therapy. Dr. Rynecki Baker limits the number of injections and avoids them in the months before a planned replacement, as recent steroid exposure affects infection risk.
• Orthobiologic injections: Platelet-rich plasma (PRP) and related options may be discussed in select cases.
• Heat, ice, and modality use: Simple measures that help many patients manage day-to-day symptoms, particularly night pain.

For patients with rheumatoid or other inflammatory arthritis, controlling the underlying disease is as important as treating the shoulder itself. Dr. Rynecki Baker coordinates with each patient’s rheumatologist, since medication management affects both the progression of joint damage and the planning around any future surgery.

Patients managing shoulder arthritis nonoperatively are followed with periodic examination and repeat x-rays when appropriate. The two changes Dr. Rynecki Baker watches for most closely are progressive loss of motion and increasing wear or bone loss in the socket, because both influence the timing of surgery and which implant will be appropriate.

Surgery may be recommended if a patient:

• Has pain that persists despite therapy, medication, and injections
• Is regularly awakened at night by shoulder pain
• Has lost enough motion or strength to be limited in work, sport, or self-care
• Finds that injections provide progressively shorter relief
• Shows advancing bone loss in the socket on repeat imaging, which can make a later replacement more complex

There is no benefit to enduring a shoulder that has stopped responding to nonoperative care, and shoulder replacement is among the most reliable pain-relieving operations in orthopedics. Dr. Rynecki Baker will give a straightforward opinion about where a patient sits on that timeline.