If you're experiencing pain or stiffness in your shoulder or you’re finding that your range of motion has decreased in the shoulder joint, you may be worried about shoulder osteoarthritis and wondering if an MRI scan is a good first step to having a diagnosis. You're in the right plce to find out more about arthritis in the shoulder and how MRI can help to rule out this degenerative condition or help you get access to treatment quicker.
This article discusses the tests you may need to get a diagnosis and how an MRI scan can help determine which part of the joint is affected, guiding your treatment.
What is Osteoarthritis of the Shoulder?
Osteoarthritis of the shoulder (glenohumeral osteoarthritis) is a degenerative joint disease, which means it gets steadily worse over time.
Osteoarthritis of the shoulder happens when the articular cartilage in one or both of the shoulder's joints deteriorates, causing pain, stiffness, and problems with mobility.
The shoulder is made up of the upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle), forming two key joints: the acromioclavicular (AC) joint, where the collarbone meets the shoulder blade, and the glenohumeral joint, where the ball of the humerus fits into the scapula's socket (glenoid). These joints are supported by the rotator cuff, a group of muscles and tendons that stabilise the shoulder.
While osteoarthritis can affect any joint in the body through simple wear and tear, the shoulders are less commonly affected, usually because they’re not usually weight-bearing joints, unlike the knees or hips.
Shoulder OA and cartilage loss become more common with age, with one overview (2020) estimating that between 16 and 20% of middle-aged and elderly people have it to some degree. However, many people with mild shoulder OA won’t notice any symptoms.
Other factors that make shoulder arthritis more likely include:
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being female
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being obese
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being Caucasian
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having a previous injury to the shoulder or rotator cuff tear
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having repeated shoulder dislocations or excessive joint movement (glenohumeral instability)
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having crystal deposits and joint inflammation in the shoulder (crystalline arthropathy)
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having an occupation or activity that involves repetitive shoulder movements, accelerating cartilage loss
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having sickle cell disease, which affects the blood supply to the bones in the shoulders
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having a family history of osteoarthritis
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being a smoker or a former smoker (according to this 2022 case-control study)
What Are the Symptoms of Osteoarthritis of the Shoulder?
People with shoulder OA will usually experience one or more of the following symptoms:
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pain during movement
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a reduced range of motion
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stiffness
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difficulty performing everyday activities, such as lifting your arms
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pain that becomes worse at night
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hearing and feeling grinding or clicking noises in the shoulder
The location of the pain can vary depending on which shoulder joint is affected. Pain centred on the back or side of the shoulder that feels like a deep ache means the glenohumeral joint is affected, while pain at the top of the shoulder or up the side of the neck means the acromioclavicular joint is affected.
Can an MRI Scan Detect Arthritis of the Shoulder?
An MRI (magnetic resonance imaging) scan is effective at detecting shoulder arthritis, particularly in identifying the soft tissue and bone changes that may happen. This is because MRI provides detailed mages of the shoulder joint. This allows your doctor to get a closer look at the bones, cartilage, tendons and ligaments and see any early signs of joint damage, such as cartilage loss, bone swelling and cysts.
How an MRI Scan Detects Arthritis of the Shoulder
An MRI scan uses strong magnets and radio waves to create an image of the soft tissues and cartilage inside the body. The scan uses magnets to align water molecules in the body’s tissues, then radiofrequency pulses to disturb the alignment. As the water molecules return to their original state, they give off signals that the computer picks up and processes to create detailed images of the shoulder joint.
MRI can reveal important signs like swelling in the bone marrow, cartilage damage and cysts forming under the cartilage. These signs help your doctor diagnose the condition much earlier. Using a special contrast dye can help them look at blood flow in the joint, giving them a better idea of how the condition is developing.
Diagnosing Arthritis of the Shoulder
Diagnosing shoulder osteoarthritis involves a thorough process to check the extent of the joint damage and any related issues. Here's an overview of the steps your clinician will take to diagnose shoulder osteoarthritis.
Medical History Review
Your doctor will ask you about the pain you’re feeling, including when it started, what makes it worse and whether it affects other areas, such as your neck or arms. They’ll also ask you about any instability, weakness or stiffness in your shoulder joint, including whether you’ve had any previous injuries, surgeries or dislocations.
If you've had trauma to the shoulder, your clinician will ask about the injury's details, like how it happened and if you felt any unusual sensations, like a ‘pop’ at the time. They'll also ask how your shoulder pain affects your daily life, such as limiting work or sports activities.
Your doctor will also ask whether you’ve had any other symptoms. This can help rule out other causes for the pain. Finally, they’ll ask about your occupation and lifestyle and whether your family has any history of osteoporosis.
Physical Examination
Your doctor will check the mobility of your shoulder and upper limbs with a series of simple tests, such as moving your arm in different directions or checking your strength by gently pushing your arm while you resist. They’ll also check your shoulder for signs of muscle wasting, swelling, bruising or deformity. They will feel around the joint (palpate) to look for tenderness, warmth or swelling.
If you experience pain when lifting your arm, your doctor will check whether you have a ‘painful arc’, usually when your arm is lifted between 70 and 120 degrees out to the side. In some cases, they may perform specific tests, like the cross-arm test, which can help pinpoint whether the pain is coming from the acromioclavicular joint. They’ll also check for any other sources of pain, as neck pain can sometimes refer pain to the shoulder. If needed, your doctor may also request a neurological exam to rule out any nerve issues.
X-Ray Imaging
If your clinician suspects that your shoulder pain is related to structural damage or arthritis, they will recommend an X-ray as the first imaging technique. X-rays are particularly useful for spotting arthritis-related changes, such as narrowing of the joint space or the presence of bone spurs (osteophytes).
MRI Scan
Your doctor may recommend an MRI for a more detailed look at the soft tissues in your shoulder. Unlike an X-ray, which mainly shows bones, an MRI provides clear images of the soft tissues inside the shoulder, such as muscles, tendons, and cartilage.
CT Scan
Sometimes, your doctor may recommend a computed tomography scan (CT), especially if the MRI scan can’t provide the detailed bone images needed or if your doctor is concerned about complex bone fractures.
Blood Tests
Blood tests can help rule out or confirm conditions like inflammatory arthritis, polymyalgia rheumatica, or even cancer. Your clinician may order a blood test if they suspect a more systemic issue, such as rheumatoid arthritis or infection. For example, if they think an infection might be causing your shoulder pain, they may order blood tests to check for signs of septic arthritis. Or if you have symptoms similar to a frozen shoulder, your clinician might suggest testing for diabetes, as it’s a condition that can be associated with this type of shoulder problem.
Joint Aspiration
If you’re experiencing a lot of swelling or fluid build-up in the shoulder joint, your doctor may recommend joint aspiration. The procedure involves drawing synovial fluid from the joint using a needle. The fluid sample can then be tested for signs of infection or inflammation. It’s usually performed under local anaesthesia.
Arthroscopy
Sometimes, your doctor may recommend arthroscopy to visualise the cartilage and other structures within the shoulder. This procedure involves inserting a small camera into your shoulder through a tiny cut. It lets your doctor see your cartilage and other structures directly and, if needed, treat any damage found. It's especially useful if earlier forms of treatment are ineffective or if your doctor thinks the problem is severe enough to warrant surgery.
Prognosis and treatment
It’s important to remember that osteoarthritis is a chronic disease for which there is no cure. However, there are many ways to ease the pain associated with osteoporosis while improving mobility and flexibility.
First-line treatment will usually involve conservative measures to reduce pain and improve shoulder joint function. They may include:
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Physical therapy: Tailored exercises can help to improve your range of motion and strengthen the muscles around the shoulder joint, helping to alleviate pain and improve your range of motion.
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Medication: Your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to help manage pain and inflammation.
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Modifying your activity: Your doctor will advise you to avoid activities that make your symptoms worse with the aim of reducing strain on the joint.
If these conservative treatments don’t improve your symptoms, your doctor may consider one of the following treatments:
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Corticosteroid or hyaluronic injections to provide pain relief, lubricate the joint, and improve range of motion.
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Injecting anaesthetic near the suprascapular nerve (suprascapular nerve block) to relieve pain.
If you have severe arthritis or your symptoms do not improve with conservative treatment or injections, your doctor may recommend one of the following surgical options.
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Arthroscopic debridement: This is a minimally invasive procedure where your doctor cleans out the shoulder joint space by removing damaged tissue and debris. It's particularly useful for treating infections in the joint.
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Total shoulder arthroplasty (TSA): In this surgery, the damaged parts of the shoulder joint are replaced with artificial components. Experts often recommend TSA for advanced shoulder arthritis because it offers significant pain relief and improved movement.
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Reverse shoulder arthroplasty (RSA): This surgery is helpful for people with complex shoulder issues, like rotator cuff tears as well as arthritis. RSA changes the way your shoulder joint works and improves function.
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Hemiarthroplasty: In this procedure, the surgeon only replaces the head of the upper arm bone (humerus) while the shoulder socket remains intact. It's less common than TSA but may be suitable for some patients.
The outlook for shoulder osteoarthritis can vary widely, depending on your age, how severe your arthritis is, your general health, and the kind of treatment you have.
For those with mild to moderate arthritis, treatments like physical therapy, pain relief and changes to everyday activities can offer a better quality of life, but bear in mind the condition may worsen with time.
Corticosteroid or hyaluronic acid injections can offer temporary pain relief, but they are a short-term treatment and are unlikely to stop the condition from progressing.
Surgical options may be the most intrusive and require more recovery time, but they are also the most effective treatments for reducing pain and improving function. However, surgery cannot reverse or cure shoulder osteoarthritis, and you may still need ongoing treatment to manage the condition and maintain joint health.
Why an MRI Scan is a Good Option
If you are being diagnosed via the NHS, your doctor is likely to order an X-ray as a first-line imaging technique, largely due to its availability and cost-effectiveness. X-rays are helpful at revealing joint space narrowing and the formation of bone spurs, two characteristics of osteoarthritis.
However, MRI can provide much more detailed images of soft tissue and bones, making this method of scanning much more effective at detecting early cartilage damage and inflammation. MRI images can also help to tell osteoarthritis apart from other shoulder issues.
Find an MRI Scan for Arthritis of the Shoulder
If you’re concerned about shoulder osteoarthritis symptoms, you can book a private MRI scan today to get answers earlier. If you’re unsure whether an MRI is right for you, one of our expert clinicians is available for a personalised consultation. They can discuss your symptoms and concerns, helping you decide the best way forward. The earlier shoulder osteoarthritis is detected, the better the potential for managing your condition effectively.
Sources
Arthritis of the Shoulder. (2024). https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-shoulder/
Ibounig, T., et al. (2020). Glenohumeral osteoarthritis: an overview of etiology and diagnostics. https://pubmed.ncbi.nlm.nih.gov/32662351/
Kruckeberg, B.M., et al. (2020). Incidence of and Risk Factors for Glenohumeral Osteoarthritis After Anterior Shoulder Instability: A US Population–Based Study With Average 15-Year Follow-up. https://pmc.ncbi.nlm.nih.gov/articles/PMC7675883/Osteoarthritis of the Shoulder. (N.D.) https://www.arthritis.org/diseases/more-about/osteoarthritis-of-the-shoulder
Osteoarthritis (OA) of the elbow and shoulder. (2020). https://versusarthritis.org/media/22725/osteoarthritis-of-the-elbow-and-shoulder-information-booklet.pdf
Osteoarthritis of the shoulder.(2023). https://radiopaedia.org/articles/osteoarthritis-of-the-shoulder?lang=gb
Scenario: Glenohumeral joint osteoarthritis. (2022). https://cks.nice.org.uk/topics/shoulder-pain/management/glenohumeral-joint-osteoarthritis/
