Shoulder Osteoarthritis: who to see and what helps

Shoulder Osteoarthritis · Kitchener, Waterloo & Cambridge

Shoulder osteoarthritis is arthritis in one of the shoulder’s two joints, bringing an ache that worsens with use, pain at night and a shrinking range of movement. Guidelines have much less to say about it than about the knee or hip, but for the main, ball-and-socket joint Ontario’s quality standard gives the same core advice: exercise to keep the shoulder strong and moving. Your first CARESPACE visit is with a physiotherapist or a chiropractor, and includes treatment as well as assessment.

What shoulder osteoarthritis is

The shoulder has two joints that can become arthritic. One is the ball-and-socket joint where the upper arm bone meets the shoulder blade (the glenohumeral joint). The other is the small joint on top of the shoulder where the collarbone meets the shoulder blade (the acromioclavicular, or AC, joint). Osteoarthritis is more common in the AC joint. Osteoarthritis explains the condition in general.

Symptoms of shoulder osteoarthritis

• Pain that is worse with activity and slowly worsens over time
• With the ball-and-socket joint, pain centred in the side or back of the shoulder
• With the AC joint, pain focused on the top of the shoulder
• Pain at night that makes sleeping difficult
• Less movement: lifting the arm to brush your hair or reach a shelf gets harder
• A grinding, clicking or snapping sound as the shoulder moves

If you are not sure this is what you have, our Shoulder Pain page compares the common causes.

What causes shoulder osteoarthritis

Shoulder osteoarthritis usually affects people over 50. The general risks for osteoarthritis apply as well, including a previous injury to the joint and work that involves heavy or repetitive use of it. Orthopaedic surgeons also describe kinds of shoulder arthritis with a specific cause: arthritis that follows a fracture or dislocation, arthritis that develops after a large, long-standing Rotator Cuff Tear, and Rheumatoid Arthritis, which usually affects the same joint on both sides of the body.

How shoulder osteoarthritis is diagnosed

An examination looks for tenderness, weakness or wasting of the muscles, range of movement, and grinding as the joint moves. Ontario’s quality standard, which covers the ball-and-socket joint, says imaging is not required for a diagnosis in people aged 40 or older with typical symptoms. X-rays can show a narrowed joint space and bone spurs, but some people have arthritis on an X-ray and few symptoms from it, so the picture is read against the examination.

When it is an emergency

Call 911 for chest discomfort (pressure, squeezing, fullness, pain, burning or heaviness), or for discomfort in the shoulder, arm, neck, jaw or back that comes with sweating, nausea, shortness of breath or light-headedness: these are signs of a heart attack.

Go to an emergency department if you cannot move the arm; if the shoulder or arm looks out of place or has changed shape; if the shoulder, arm or hand has no feeling, or is cold, pale or bluish; or if you have injured the shoulder and it is painful, bruised or swollen. The shoulder may be dislocated or broken, and a nerve or blood vessel may be affected. Do not try to push it back in, do not drive yourself, and call 911 if you have no safe way to get there.

A joint infection comes on quickly, usually over a few days; osteoarthritis does not. The NHS, the UK’s health service, gives these signs of one: severe pain in a joint, usually just one, that started suddenly; swelling around a joint; a change in the colour of the skin around a joint; difficulty moving a joint; or joint pain along with feeling generally unwell and a high temperature, or feeling hot, cold or shivery. Ontario’s quality standard adds chills and sweats, and names a hot, swollen joint as a feature that needs investigating. If you develop any of these, go to an urgent care clinic or an emergency department the same day. A joint infection is serious and should be treated as soon as possible, usually in hospital, so it is not something to bring to an appointment with us.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

Get medical care the same day, from a physician or nurse practitioner, an urgent care clinic or an emergency department, if there was no injury and the pain is very bad, if you have pins and needles that do not go away, or if both shoulders are severely painful. Shoulder Pain has the full list of warning signs for shoulder problems of every kind.

See a physician or nurse practitioner if morning stiffness lasts longer than about 30 minutes or your symptoms are getting worse quickly. Neither fits the usual pattern of osteoarthritis, and either may call for blood work, imaging or another diagnosis, such as rheumatoid arthritis.

What the evidence says about treating shoulder osteoarthritis

• There is less of it. The American rheumatology guideline for osteoarthritis does not cover the shoulder. These points come from Ontario Health’s 2024 quality standard, the UK’s NICE guideline (2022), which applies to any joint, and the American Academy of Orthopaedic Surgeons’ 2020 guideline. The Ontario standard and the surgeons’ guideline are about the ball-and-socket joint only; for the AC joint there is NICE’s general advice and little else. Much of the surgeons’ non-surgical advice is labelled “consensus”, meaning it rests on the panel’s opinion because no reliable studies were found.
• Exercise is still the core. Progressive strengthening, neuromuscular training and aerobic exercise are strongly encouraged by Ontario’s standard, and NICE says to offer therapeutic exercise to everyone with osteoarthritis. The surgeons’ consensus is that physiotherapy may benefit selected people, with a caution that overzealous therapy may increase pain.
• Hands-on treatment: not supported for the shoulder. NICE says to only consider manual therapy (manipulation, mobilization or soft-tissue techniques) for hip or knee osteoarthritis; its committee found no evidence for other joints.
• Acupuncture, dry needling and TENS. NICE says do not offer any of them for osteoarthritis. The surgeons say they cannot recommend for or against acupuncture, dry needling, TENS or cupping, for want of credible evidence of benefit or harm.
• Glucosamine and chondroitin. NICE says do not offer glucosamine, Ontario’s standard does not recommend either for slowing the disease, and the surgeons cannot recommend for or against them.
• Hyaluronic acid injections: no. The surgeons found strong evidence of no benefit, and Ontario’s standard says they should not be used. Platelet-rich plasma and stem cell injections cannot be recommended, in the surgeons’ view.
• Keyhole surgery: uncertain. NICE says do not offer arthroscopic washout or debridement for osteoarthritis; the surgeons say non-replacement surgery may or may not give short-term benefit.

What a doctor may offer

CARESPACE does not provide these, but it helps to know where they fit. Ontario’s standard says medicines are offered when non-drug treatment is not enough, starting with a topical treatment for the shoulder, and that a corticosteroid injection may be considered judiciously; the relief from an injection is often temporary. Both the Ontario standard and the surgeons say opioids should not be used routinely. NICE says to consider referral for a shoulder replacement when symptoms are substantially affecting quality of life and non-surgical treatment is ineffective or unsuitable, and the surgeons found that replacing both the ball and the socket gave better function and pain relief in the short to medium term than replacing the ball alone. For arthritis of the AC joint, the most common operation removes a small piece from the end of the collarbone.

How each CARESPACE service treats shoulder osteoarthritis

Physiotherapy

A physiotherapist can find out which movements the shoulder has lost and where it is weak, then set exercises for range of motion, strength and function. Keeping the load within what the joint tolerates matters here, because overdoing it may increase pain, and so does changing how you do the tasks that provoke it.

See our physiotherapy team →

Chiropractic

A chiropractor can examine the shoulder together with the neck and upper back, prescribe exercise and advise on activity. Hands-on treatment is a different matter for this joint: the UK guideline says to consider it only for the hip or knee, having found no evidence for other joints, so it is not a supported treatment for an arthritic shoulder.

See our chiropractic team →

Kinesiology

A kinesiologist can run progressive strengthening and aerobic exercise and adjust them as the shoulder allows. That matters in the arm: Ontario’s standard notes that osteoarthritis there commonly lowers quality of life through weakness that affects what the hand and arm can do.

See our kinesiology team →

Other services people ask about

Massage therapy. Soft-tissue techniques are part of the manual therapy that NICE limits to the hip and knee, the surgeons’ guideline does not mention massage, and Arthritis Society Canada says there is not enough research evidence to say massage should be recommended for osteoarthritis. Acupuncture. NICE says not to offer it, the surgeons cannot recommend for or against it for the shoulder, and Arthritis Society Canada calls the research on arthritis symptoms limited.

Where most people start

Start with a physiotherapist or a chiropractor. Both assess and treat at the first visit.

How your team works together

Exercise is the main non-drug treatment the guidelines support for this joint, so the team is small: a physiotherapist or chiropractor to assess the shoulder and set the plan, and a kinesiologist if you want supervised strengthening. If that has not helped enough, the next steps are medical, and your practitioner can tell you when it is time to see a physician about medicines, an injection or a surgical opinion.

Browse by service: physiotherapists, chiropractors and kinesiologists.

What to expect at your first visit

1. The history. Where on the shoulder it hurts, what nights are like, old fractures, dislocations or rotator cuff problems, and what you can no longer reach.
2. An examination. How far the arm lifts and turns, strength, tenderness over each joint, and any grinding.
3. A check that it fits osteoarthritis, and whether a physician should see it.
4. Treatment that day, and a few exercises to start at home.

What you can do at home

• Change how you use the arm to avoid the movements that provoke pain, without giving up using it.
• Moist heat can give temporary relief. Ice for 20 to 30 minutes, two or three times a day, is the other option.
• Lift at waist height where you can, and break heavy or repetitive jobs into shorter spells.
• Ask a pharmacist, physician or nurse practitioner before taking glucosamine or chondroitin: there is little scientific evidence to support them.

Clearing a driveway after a Waterloo Region snowfall is heavy, repetitive lifting: exactly the kind of job to break into shorter spells.

Outlook

Shoulder osteoarthritis is long-term, and the pain typically worsens with time. No source we read gives a timetable for improvement with exercise. When non-surgical treatment is no longer enough, surgery for shoulder arthritis is, in the surgeons’ words, generally very effective in reducing pain and restoring motion.

Shoulder osteoarthritis treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Chiropractic in Kitchener and Kinesiology in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Chiropractic in Waterloo and Kinesiology in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Is shoulder arthritis the same as a rotator cuff problem?

No, though they are linked. A large, long-standing rotator cuff tear can itself lead to arthritis, because the torn cuff can no longer hold the ball of the joint in its socket.

Which part of the shoulder is arthritic?

Pain focused on the top of the shoulder points to the AC joint. Pain centred in the side or back of the shoulder points to the ball-and-socket joint. An examination confirms it.

Do I need an X-ray?

Not to make the diagnosis, if you are 40 or older with typical symptoms. X-rays matter before a surgical consultation.

Will a cortisone injection help?

It can reduce pain, but the effect is often temporary. Ontario’s standard says injections may be considered judiciously. They are given by a physician, not at CARESPACE.

When is a shoulder replacement considered?

When symptoms are substantially affecting your quality of life and non-surgical treatment is ineffective or unsuitable. That is the UK guideline’s test, and the referral comes from a physician or nurse practitioner.

Where can I get treatment for shoulder arthritis in Cambridge?

Physiotherapy in Cambridge is the place to start. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Ontario Health. Osteoarthritis: Care for Adults With Osteoarthritis of the Knee, Hip, Hand, or Shoulder. Quality standard, 2024.
• National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226). 2022. Full text on the NCBI Bookshelf.
• American Academy of Orthopaedic Surgeons. Management of Glenohumeral Joint Osteoarthritis: Evidence-Based Clinical Practice Guideline. 2020.
• American Academy of Orthopaedic Surgeons, OrthoInfo. Arthritis of the Shoulder. No review date is shown on the page.
• Arthritis Society Canada. Osteoarthritis. Reviewed February 2021.
• NHS. Septic arthritis. Reviewed September 2026.
• Heart and Stroke Foundation of Canada. Signs of a heart attack.
• NHS. Dislocated shoulder. Reviewed September 2026.
• NHS. Shoulder pain. Reviewed May 2023; its next review was due in May 2026.
• American Academy of Orthopaedic Surgeons, OrthoInfo. Shoulder Dislocation.

Related conditions

Osteoarthritis
Shoulder Pain
Rotator Cuff Tear
Frozen Shoulder

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