Medical Treatment for Osteoarthritis of the Shoulder

If osteoarthritis of the shoulder causes aching pain and limits your ability to move without discomfort, your doctor may recommend an over-the-counter pain relief medication. Many doctors recommend acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin, ibuprofen, and naproxen. These medications are taken by mouth.

Acetaminophen blocks pain signals that travel from an inflamed joint to the brain, and NSAIDs relieve pain and swelling that result when the body’s immune system responds to joint damage caused by arthritis. 

Many people find that over-the-counter pain relief medications alleviate aching and stiffness in arthritic joints, making movement easier and helping them to remain active. Your doctor can explain the risks of using these medications and recommend a safe regimen for you based on your symptoms, age, and other medical conditions, which can affect or interact with these medications. 

Although acetaminophen is safe in moderate doses, long-term use can lead to liver damage. Anti-inflammatory medications may also produce side effects, such as high blood pressure, headaches, upset stomach, and kidney damage, especially with long-term use. 

If over-the-counter medications don’t help to relieve your pain and stiffness from osteoarthritis within several weeks, your doctor may prescribe a stronger medication, such as a more potent anti-inflammatory medication.

Rehabilitation specialists at NYU Langone’s Rusk Rehabilitation are experienced in treating osteoarthritis of the shoulder, and they can customize a routine of physical movements to build muscle strength, improve flexibility, and restore range of motion in the shoulder. 

Our physical therapists and physiatrists, who are doctors specializing in rehabilitation, design a routine of simple exercises that you can incorporate into your home or gym routine. At first, exercises to stretch muscles and tendons in the shoulder can help improve mobility and flexibility. After you can perform these exercises without pain, your therapist gradually incorporates strengthening exercises to build muscle tone. 

Stronger muscles provide support for the shoulder joint, and increased flexibility and range of motion may reduce stiffness and alleviate discomfort during arm movement. 

Your doctor may recommend physical therapy for four to eight weeks, at which time the therapist determines whether additional therapy is needed.

If pain medication doesn’t provide relief, doctors may recommend an injection of medication directly into the arthritic joint. Our orthopedic and rheumatologic specialists often use ultrasound—in which high-frequency sound waves create images of the inside of the body—to guide the injection precisely into the joint, ensuring that the medication has maximum effect. 

Corticosteroid Injection

Corticosteroids are anti-inflammatory medications that may provide pain relief when injected directly into the shoulder joint. Corticosteroids reduce inflammation, which is part of the body’s immune system response and causes pain and swelling. 

Typically, doctors inject a small amount of anesthetic in addition to the corticosteroids to provide short-lasting but immediate pain relief. The anesthetic wears off a few hours after the injection, at which time shoulder pain may return. The corticosteroid solution begins to work two to three days later. In some people, a corticosteroid injection provides pain relief that lasts for many months, although in others it can be less effective. 

Doctors recommend no more than two or three corticosteroid injections in the shoulder joint. If used too frequently, corticosteroid use may lead to infection, discoloration at the injection site, or a weakening of the shoulder structure that increases the risk of an injury, such as a torn tendon.

Hyaluronic Acid Injection 

The shoulder joint contains a small amount of a gel-like substance called synovial fluid. This fluid cushions and lubricates the joint. Synovial fluid has a component called hyaluronic acid, which helps to make it viscous, or sticky and thick. If synovial fluid thins out, it becomes less effective as a lubricator. 

Doctors at NYU Langone can inject hyaluronic acid—typically produced in a laboratory—into synovial fluid in the shoulder joint to increase the fluid’s viscosity and improve the joint’s gliding motion. This improved joint function may provide pain relief that lasts for weeks or months. Doctors recommend limiting hyaluronic injections to one per year. This procedure has been found to be safe and rarely has side effects.

Hyaluronic acid injections bring relief for some people, but this technique has not been scientifically proven to have positive effects, and doctors can’t predict when an injection is going to be effective. Our doctors are continuing to explore the effectiveness of these injections. 

Until they are approved by the U.S. Food and Drug Administration as a treatment for osteoarthritis of the shoulder, hyaluronic acid injections remain an experimental treatment option. Most insurance companies do not cover the cost of the procedure. 

Recovery from Therapeutic Injections

Most people return home an hour or two after the injections. The site of injection may be swollen or tender for one or two days, and doctors may recommend an over-the-counter pain medication to relieve pain and reduce swelling.

Acupuncture is a therapeutic technique in which specialists insert very thin needles into various points on the surface of the body. By targeting specific points along “meridians” that correspond to the nerve pathways affected by osteoarthritis of the shoulder, acupuncture may stimulate healing by increasing blood flow and can improve joint function. Acupuncture may also prompt the body to release endorphins, which are natural pain relievers. 

Our licensed acupuncturists administer this therapy in a relaxed setting at NYU Langone. Acupuncture needles are left in place for 20 to 40 minutes. For optimal results, doctors may recommend several acupuncture sessions.