Shoulder arthritis symptoms do not develop overnight; your stiffness and pain gradually gets worse. Over time you notice more discomfort and that the stiffness takes longer to ease with movement and that too much activity will aggravate your symptoms. As the condition progresses you will experience pain more frequently, it will last for longer periods of time and eventually your pain will be constant.
Pain will get worse with too much activity and relieved by rest, but complete rest will also cause more pain. Symptoms are worse in the mornings with stiffness in all directions, which takes about 30 minutes to ease. The longer it takes to ‘settle’ or ‘get moving’ the more advance your shoulder arthritis is.
As the condition gets worse you will find that you lose range of motion of your shoulder, like when you lift your arm up to hold your phone to your ear. The quicker you see your Physiotherapist, the quicker we can manage your pain and stiffness and start with to correct management and rehabilitation.
We can divide arthritis into four different stages of severity. What you experience in each of these stages might be different, depending on your type of arthritis, background and history.
In the first stage of shoulder arthritis you will only have minor symptoms. There could be some osteophytes on X-rays, but you might feel more discomfort rather than pain. These symptoms come and go and don’t interfere with your daily routine. You can feel some stiffness in the morning when you get up, but this eases as soon as you start moving around. Pushing on the arm to get up or overhead activities makes you aware of slight discomfort. You are feeling these symptoms due to the inflammation in your joint.
During the disease process of Phase 1 rheumatoid arthritis you get the inflammation initially due to the body mistakenly attacking your own joint tissue (auto-immune disease). During osteoarthritis you will have inflammation in stage 1 due to the wear and tear in your joint irritating the synovium – it is your bodies own way to prevent further damage.
You will start to notice stiffness more often, like after a long drive or sitting at your desk for a couple of hours. You’re more aware of the shoulder on a cold day. Pain in your shoulder or neck at times, but you are still able to carry on with your daily routine. Reaching for something or picking up an object like grocery bags becomes sensitive. This is because the x-rays will now show osteophytes (bone growths) around the shoulder joint, but no narrowing of your joint space.
In the third stage of shoulder arthritis your symptoms will become more noticeable. You will find that your discomfort has changed to pain which can interfere with your daily activities. You might notice that you start avoiding certain movements or positions, like sleeping on your shoulder or getting dressed in the morning is a challenge. At this stage you will probably also struggle to lift up your arm and pain can start shooting down your arm. Other activities that cause pain are pushing on the arm, holding your steering wheel in the car and working for an hour brings on the stiffness. On X-rays this is confirmed by some damage to the cartilage inside your shoulder joint and we will see narrowing of your joint space.
If you have rheumatoid arthritis your joint can become crooked due to the formation of fibrous connective tissue during this stage, this is not the case in osteoarthritis.
At this point you will have constant, severe pain that wakes you up during the night. You will struggle to find a comfortable position to fall asleep in. Opening doors and getting dressed will be extremely painful and all movements of your shoulder will be limited. Your shoulder will be painful when you get out of bed in the morning and you could notice “locking” and “clicking” of your joint with most movements. On your X-rays there will be no visible joint space – which means that the cartilage is worn away – and a large number of osteophytes is present.
During the final stage of rheumatoid arthritis your joints will fuse together as one unit (called bony ankylosis), this will be visible on your x-ray. This is however not the case in stage 4 osteoarthritis.
Always remember that x-rays can tell us what your joint looks like on the inside, but this does not determine your pain levels. Pain and stiffness can be managed and you might even have days where you are PAIN FREE! We want to help you reach that phase, no matter the stage of arthritis you are in.