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For more information, go to www.arthritisresearchuk.org

What treatments are there for shoulder pain?

My husband has arthritis in both shoulders and has a lot of pain, especially at night when he can't get comfortable and pain keeps him awake. He takes normal painkillers and every three months or so has cortisone injections from the doctor. But despite this the condition is getting worse and the pain is increasing.

We were wondering if going to the gym and getting advice from them would help, or sauna and steam?  He's tried glucosamine but says it doesn't help. I've asked him to try massage, but as yet I haven't persuaded him. What would you recommend?
Marged Jones, via email (Summer 2015)

Dr Tom Margham answers:

Dr Tom MarghamAnyone who’s experienced shoulder pain will empathise with your husband. There’s an awful lot of activities of everyday living that rely on our shoulders working well. You’re on the right track with your thoughts on going to the gym though.

The shoulder is an amazing joint – combining strength with the largest range of movement of any joint in the body. The price we pay for this range of movement however is that the joint is very prone to problems relating to muscle weakness or imbalance, which happens very quickly in a painful joint. Poor muscle control leads to a sloppy joint that is unstable and painful.

Physiotherapy followed by continued work to strengthen the muscles of the shoulder and keep the flexibility and range of movement is the order of the day here. This can be combined with treatments like injections every now and then as needed to control the pain, so that the exercises are possible.

If things continue to worsen despite treatments like physiotherapy and injections then shoulder surgery may be an option. An orthopaedic surgeon can advise if arthroscopy (keyhole surgery) will help or whether a shoulder joint replacement is required. But technology and expertise in shoulder replacements is many years behind that of knee and hip replacements. So they're used more as a last resort to help manage pain and don’t have anything like the function of the original joint.

So in summary – press on with exercises, physiotherapy, painkillers and injections as necessary, with surgery as an option if these things don’t help.

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