---
title: "Shoulder Arthritis"
---

## When Your Shoulder Decides You Can't Sleep On That Side

Shoulder arthritis tends to announce itself in specific ways. Pain when you reach overhead. Difficulty putting on a shirt or jacket. The realization that you cannot sleep on that shoulder anymore. Tennis or golf shots that do not feel right. Hairstyling, reaching for items on shelves, or buckling a seatbelt becomes an effort.

Many shoulder arthritis patients are surprised by how much the condition affects sleep. The shoulder is non-weight-bearing during the day, but lying on it at night puts pressure on the arthritic joint, and patients often describe waking up repeatedly trying to find a comfortable position. Most patients we see have been told either that they will need a replacement eventually or that there is nothing to do but modify activities and take anti-inflammatories. Both framings skip over the meaningful treatment options that exist at most stages.

## What Shoulder Arthritis Actually Is

Your shoulder is the most mobile joint in your body. The term shoulder arthritis usually refers to the glenohumeral joint, where the head of your humerus sits in the shallow socket of your shoulder blade. This joint trades stability for mobility: the shallow socket allows enormous range of motion but relies heavily on surrounding structures, especially the rotator cuff, for stability. When arthritis develops, the cartilage between the bones wears down, producing pain, stiffness, and reduced range of motion.

Common forms include glenohumeral osteoarthritis (the most common), rheumatoid and other inflammatory arthritis (coordinated with rheumatology), post-traumatic arthritis, cuff tear arthropathy (which develops after long-standing rotator cuff tears), and acromioclavicular joint arthritis at the top of the shoulder. Each requires somewhat different evaluation and treatment.

## A Common Diagnostic Question, Arthritis or Rotator Cuff?

One of the most common diagnostic questions for shoulder pain in patients over 50 is whether the primary issue is arthritis, a rotator cuff problem, or both. The two often coexist, and patients labeled with shoulder arthritis sometimes have rotator cuff issues that are actually more responsible for their symptoms.

Treatment recommendations vary significantly based on which is dominant. PRP for rotator cuff tendinopathy is different from regenerative treatment for arthritis. Knowing which is driving the pain matters, which is part of why thorough evaluation matters. Many shoulder pain patients arrive having been treated for the wrong primary diagnosis. Common features of shoulder arthritis include pain with overhead activities, night pain when lying on the affected side, gradual stiffness and reduced range of motion, deep pain rather than at a specific surface point, and cracking or grinding with movement.

## How PHI Treats Shoulder Arthritis

Treatment begins with a comprehensive evaluation: a detailed history, an examination assessing range of motion, strength, and patterns suggesting joint versus rotator cuff involvement, and review of imaging. Based on that, options include:

Image-guided shoulder injections with cortisone for inflammation. The shoulder is a joint where image guidance significantly improves accuracy because surface landmarks often misidentify the precise target, so PHI uses image guidance for every shoulder injection, with cortisone's cumulative considerations discussed honestly. PRP therapy, particularly useful for shoulders with combined arthritis and rotator cuff components. A2M therapy, which neutralizes cartilage-destroying enzymes and is relevant for early-to-moderate arthritis. Stem cell therapy for moderate to severe arthritis or after PRP. Exosome therapy within comprehensive protocols. When shoulder replacement is appropriate, we coordinate with orthopedic specialists; modern reverse shoulder arthroplasty has made replacement possible for patients with cuff tear arthropathy who previously had few options.

## When to See Someone

Consider professional evaluation when your shoulder pain has lasted more than four to six weeks without improvement, when it interferes with sleep or daily activities, when you are avoiding overhead activities or work tasks, when you want to understand non-surgical options, or when you are considering replacement and want to explore alternatives first.

Seek prompt evaluation if you experience sudden severe shoulder pain following an injury, significant new weakness in the arm, inability to lift the arm, or significant joint swelling, warmth, or redness.

## Why PHI for Shoulder Arthritis

## Frequently Asked Questions

**Q: How is shoulder arthritis different from rotator cuff problems?**

Shoulder arthritis specifically involves cartilage breakdown in the joint. Rotator cuff problems involve the muscles and tendons that surround and stabilize the shoulder. The two often coexist, and patients sometimes have one labeled as the cause when the other is actually more responsible. Treatment approaches differ significantly, so identifying which is dominant matters.

**Q: Will I need a shoulder replacement?**

This depends on the stage of your arthritis, the condition of your rotator cuff, and how your shoulder is affecting your life. Many patients with mild to moderate arthritis manage successfully with non-surgical treatment. Patients with advanced arthritis often eventually benefit from replacement, and modern reverse shoulder arthroplasty has made replacement possible for patients who were not candidates for traditional replacement.

**Q: Why do shoulder injections need image guidance?**

The shoulder has multiple potential injection targets, and surface landmarks alone often misidentify which target the needle is reaching. Image guidance ensures the medication actually goes where intended, which significantly improves both safety and effectiveness.

**Q: Are repeated cortisone injections safe for the shoulder?**

Cortisone is well-established for shoulder arthritis. Like other joints, repeated frequent cortisone has cumulative considerations. For most patients occasional cortisone is appropriate. For patients requiring frequent repeat injections, regenerative options often make more sense.

**Q: Can I exercise with shoulder arthritis?**

Yes, with appropriate adjustments. Maintaining shoulder mobility through gentle range-of-motion work is important, and strengthening the rotator cuff and surrounding muscles often helps support the joint. Heavy overhead loading or impact may need modification. A physical therapist who understands shoulder arthritis can help significantly.

**Q: Will I get my range of motion back?**

This depends on how much range you have lost and what is causing the limitation. Some range loss can be improved with targeted treatment combined with physical therapy. Some range loss from advanced arthritis is structural and may not fully return without surgery. We are honest about realistic expectations.

**Q: What about reverse shoulder replacement?**

This is a specific type of shoulder replacement designed for patients with significant rotator cuff problems alongside arthritis. It has been a major advance for patients who previously did not have good surgical options. PHI does not perform shoulder replacement but coordinates referral when this evaluation is appropriate.

**Q: Do you take insurance?**

Insurance coverage and payment options may vary. All pricing is disclosed at consultation.

**Q: Do you accept international patients?**

Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations.

## Treatments We Offer for Shoulder Arthritis

PHI offers the full range of evidence-based treatments for shoulder arthritis. Your physician will recommend the right option, or combination, based on the stage of your arthritis, whether other shoulder structures are involved, your goals, and your treatment history.

- Shoulder Injections, image-guided cortisone for inflammation
- PRP Therapy
- Stem Cell Therapy
- A2M Therapy
- Exosome Therapy

> The effect of intra-articular corticosteroids on articular cartilage: a systematic review. Peer-reviewed via PubMed.
— [Wernecke C, et al.](https://pubmed.ncbi.nlm.nih.gov/26674652/)

> Clinical practice guideline: management of glenohumeral joint osteoarthritis. American Academy of Orthopaedic Surgeons.
— [American Academy of Orthopaedic Surgeons](https://www.aaos.org/quality/quality-programs/upper-extremity-programs/glenohumeral-joint-osteoarthritis/)

## Schedule Your Shoulder Arthritis Consultation

A 60-minute consultation will identify what stage of shoulder arthritis you are dealing with, whether other shoulder structures are involved, walk through the treatment options that match your situation, and give you a clear plan. Call (310) 856-9488 or book online now.


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