Table of ContentsView AllTable of ContentsSymptomsThe Shoulder JointCausesConditions Linked to RADiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
The Shoulder Joint
Causes
Conditions Linked to RA
Diagnosis
Treatment
Rheumatoid arthritis(RA) is known for causing all-over inflammation and pain. It happens when the immune system malfunctions and attacks thesynovium, the lining of the joints. RA can target the synovial lining of the shoulder joint.
People with RA have an increased risk of shoulder problems as a consequence of ongoinginflammation. While the number of people with shoulder problems in the general population is smaller, people with RA will have notable shoulder tenderness and swelling as early as two years after diagnosis.
This article discusses the symptoms and conditions associated with shoulder RA, as well as diagnosis and treatment options for shoulder RA.
Moyo Studio/Getty Images
Anatomy of the Human Shoulder Joint
What Are the Symptoms of RA in the Shoulders?
People with RA who have shoulder involvement will have pain in both shoulders.About 5% of people with RA report shoulder pain within two years, and after 12 years of living with the condition, 96% will have erosive shoulder damage.
Additional shoulder symptoms experienced with RA may include:
Shoulder involvement tends to be worse in people who have long-term RA and who are older at the onset of the disease.As shoulder involvement worsens, movement of the shoulder gets harder and there may be significant pain. Night pain is common and makes it harder to sleep.
Does RA Affect One Shoulder or Both?Because RA is a symmetrical condition—affecting the same joints on both sides of the body—people with shoulder RA often experience pain and swelling in both shoulders at once. Shoulder RA may cause erosion and deformity of the shoulder joints over time.
Does RA Affect One Shoulder or Both?
Because RA is a symmetrical condition—affecting the same joints on both sides of the body—people with shoulder RA often experience pain and swelling in both shoulders at once. Shoulder RA may cause erosion and deformity of the shoulder joints over time.
About the Shoulder Joint
The shoulder is made up of three bones: thehumerus(the upper arm bone), the clavicle (collarbone), and thescapula(shoulder blade).Two joints in the shoulder help it to move: theacromioclavicularjoint and theglenohumeraljoint.
The acromioclavicular joint is located where the highest point of the scapula meets the clavicle. The glenohumeral joint is the ball and socket joint between the scapula and humerus.
What Causes RA in the Shoulders?
It is not known what causes RA in the shoulders specifically or why some people develop this chronic condition. RA is an autoimmune disease, which means the immune system attacks its own tissues (such as cartilage and ligaments) and softens bone.
Shoulder Conditions Linked to RA
Rheumatoid arthritis has been linked to other shoulder conditions because of chronic inflammation. This includes rotator cuff degeneration and tears, frozen shoulder syndrome, and bursitis.
Rotator Cuff Degeneration
The rotator cuff is a group of four tendons that stabilize the shoulder joint. These tendons connect to four muscles that help to move the shoulder in various directions.
Research shows that people with RA have a higher risk of rotator cuff degeneration and tears.Ongoing RA inflammation can cause the rotator cuff to become damaged.
What Is Rotator Cuff Pain?
Frozen Shoulder Syndrome
Symptoms will begin gradually and eventually get worse. Over time, frozen shoulder causes shoulder movement to become harder. The condition tends to resolve within three years.
Treatment for frozen shoulder can help resolve symptoms, reduce pain, and improve range of motion and muscle strength in the affected shoulder.
Adhesive Capsulitis Overview
Bursitis
Bursitiscauses inflammation of thebursae, the small, fluid-filled sacs found near the joints. Bursitis of the shoulder causes painful inflammation of the shoulder joint extending into the upper arm.
Bursitis pain increases with movement, especially with lifting the arms above the head. RA is known for causing bursitis because of the ongoing inflammation it produces.
Shoulder Bursitis Overview
How Is RA in the Shoulders Diagnosed?
Your healthcare provider will also perform a physical examination, which will look for:
Your healthcare provider will also order X-rays to look for narrowing of the joint space, changes to bone, and the formation of bone spurs.
Another method of diagnosis involves injecting a local anesthetic into the shoulder joint. If the injection helps relieve pain, then a diagnosis of RA in the shoulder joint can be made.
How Is RA in the Shoulders Treated?
Shoulder symptoms will also be treated separately. Treatment for shoulder RA may include:
Range of Motion Exercise
Treatment for shoulder RA often starts withrange of motion exercisesto keep your shoulder mobile. If range of motion has not been affected, the goal will be to prevent things from getting worse.Physical therapycan help teach you exercises to strengthen your shoulders and improve range of motion.
A physical therapist will give you guidelines regarding how long you should do the range of motion exercises each day.
Assistive Devices
Your physical or occupational therapist may suggestassistive devicesto help you with tasks that have become harder. One popular device is a reacher, which helps you to remove and replace objects from high places without having to lift your arm. There are also assistive devices that can help you get dressed, such as zipper pulls and dressing sticks.
Pain Control
Pain control can be accomplished in several ways.
When to Use Heat and When to Use Cold
Intra-Articular Injections to Treat Joint Disorders
Lifestyle Modifications
Your healthcare provider may suggest you avoid or cut off activities that make your shoulder painful, especially if the pain is affecting you daily or keeps you up at night.
For example, if you play a sport that requires shoulder and arm movement, you may want to stop doing it or cut down on how often you play that sport. Or if your job requires lifting, you may want to ask your employer for lighter duty where you are not doing as much lifting or carrying of heavy objects.
Surgery
Although it’s used as a last resort, surgery might be needed for people who don’t respond to nonsurgical therapies. Surgical options may include:
Summary
Treatment options for shoulder RA include range of motion exercises, pain control, lifestyle modifications, and surgery (as a last resort). Talk to your healthcare provider if you have rheumatoid arthritis and start to develop shoulder pain or other shoulder symptoms. Since these symptoms can get worse with time, you shouldn’t ignore them. Your practitioner can order imaging and bloodwork to help determine the source of shoulder pain and symptoms.
Causes of Shoulder Pain and When Is It Serious?
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Johns Hopkins Medicine.Shoulder arthritis.
American Academy of Orthopaedic Surgeons.Arthritis of the shoulder.
Arthritis Foundation.Shoulder anatomy.
Wang WT, Huang SW, Liou TH, et al.Patients with rheumatoid arthritis were associated with a risk of rotator cuff diseases.J Clin Med. 2019;8(2):129. doi:10.3390/jcm8020129
Tzeng CY, Chiang HY, Huang CC, et al.The impact of pre-existing shoulder diseases and traumatic injuries of the shoulder on adhesive capsulitis in adult population: A population-based nested case-control study.Medicine (Baltimore). 2019;98(39):e17204. doi:10.1097/MD.0000000000017204
American Academy of Orthopaedic Surgeons.Frozen shoulder.
Todd DJ.Patient education: Bursitis (Beyond the basics). UpToDate.
Kamineni S, Unger RZ, Desai R.Shoulder arthrodesis in the management of glenohumeral pathologies. Journal of Shoulder and Elbow Arthroplasty. doi: 2019;3:247154921985065.
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