Shoulder arthritis: when the stiff, aching shoulder is not your neck

Shoulder arthritis is wear of the cartilage in the ball-and-socket joint of the shoulder. It causes deep pain, stiffness and grinding, often with night pain, and it is easy to confuse with pain from the neck. Before a shoulder replacement, PRP or bone marrow concentrate placed in the joint can ease pain and keep you moving.

What does shoulder arthritis feel like?

The pain sits deep in the joint, at the front or back of the shoulder rather than on top. It is worse reaching up to a shelf, behind your back, or out to the side. Many people feel or hear grinding. Night pain is common, most of all lying on that side.

Stiffness is the giveaway. A worn shoulder loses motion in every direction, both when you move it and when someone else moves it for you. Most rotator cuff problems hurt but still let a doctor move the arm all the way. Arthritis does not.

Is it my shoulder or my neck?

This site is about the neck, so this is the question we hear most. The C5 and C6 nerve roots supply the shoulder area. A pinched nerve or a worn facet joint at those levels can send pain to the same spot. Many people over 55 have wear in both places, so the neck MRI and the shoulder X-ray can both look guilty.

• Shoulder arthritis hurts with arm movement and limits how far the arm goes. Turning your head does not change it.
• Neck-driven pain changes with head position. Looking up or turning toward the sore side brings it on, and the shoulder still moves fully.
• Nerve pain often runs past the elbow, with tingling or weakness.

When the exam leaves doubt, a numbing injection into the shoulder joint settles it. If the pain fades for a few hours, the joint is a main source. Our page on neck or shoulder pain covers the full test list, and shoulder pain that starts in the neck covers the other side.

What causes shoulder arthritis?

Old injuries are a big cause: a dislocation, a fracture, or years of heavy overhead work. A large rotator cuff tear left alone for years can wear the joint in its own pattern. Some people simply inherit thinner cartilage.

Then there is the body around the joint. Insulin resistance, high blood sugar and belly fat keep the whole body running inflamed, and the joint lining feels it. That is part of why shoulder arthritis often shows up alongside knee and hand arthritis in the same person. We look at that side of the picture too, because an injection cannot outrun a body that keeps feeding the fire.

Which injections help shoulder arthritis?

• Cortisone gives fast relief that often fades within weeks. Repeated doses are hard on cartilage.
• Hyaluronic acid adds lubrication. Benefits in the shoulder are steady but modest.
• PRP concentrates your own platelets. Their growth signals calm the joint lining and support the cartilage cells that remain. Relief builds over weeks and tends to last longer.
• Bone marrow concentrate adds cells and signals that PRP lacks. We consider it for more advanced wear.
• Microfragmented fat is another option for a worn joint. It is processed from a small fat sample taken the same day.

The product name matters less than two things: how much active material reaches the joint, and what you do afterward. A dose too small to matter, or a perfect injection followed by no rehab, both lead to the same letdown.

What does the research say about PRP for shoulder arthritis?

A 2025 review of injection treatments for shoulder arthritis covered 1,125 patients. It found injections can ease symptoms. Only 3.2% went on to surgery during follow-up.

A 2025 trial in long-standing shoulder pain compared joint PRP with a cortisone and numbing mix. Cortisone won in the first month. PRP gave lower pain from two to six months and better satisfaction at six months. In 2026, an international expert panel reached consensus on using PRP for shoulder arthritis, while calling for standard dosing.

Our position covers mild to moderate shoulder wear that has not settled with exercise. For that, a guided, dosed PRP injection is a reasonable step before anyone books a replacement.

What happens at a shoulder PRP visit?

You are awake the whole time. Local anesthetic numbs the skin, with no sedation, so most people drive home. We draw blood, spin it, and place the platelet concentrate into the joint under ultrasound so we can watch the needle land. Expect a deep ache for about 48 hours. Avoid ibuprofen and similar pills for a while afterward.

Then rehab starts: gentle motion first, then strength for the rotator cuff and the shoulder blade muscles. The number of injections depends on how you respond. Orthobiologic care is delivered at our regenerative clinic, 4477 Woodson Rd in St. Louis, and front desk staff route you at check-in. PRP is not covered by insurance. HSA and FSA funds are generally eligible.

What can you do for shoulder arthritis at home?

• Move the shoulder every day through the range you have. Pendulum swings and wall slides keep a stiff joint from locking down further.
• Warm the shoulder before you use it. A warm shower before reaching work helps more than ice after.
• Keep heavy items at waist height so you are not reaching overhead with load.
• Sleep with the sore arm supported on a pillow so the joint is not hanging open all night.
• Watch the sugar and the waistline. A joint lining bathed in high insulin stays angry, and no injection fixes that by itself.

None of this rebuilds cartilage. It buys the joint a calmer place to live, which makes every treatment work better and last longer. People who keep moving between visits do better than people who wait for the shot to do all the work.

When is a shoulder replacement the right call?

When the joint has collapsed, the ball has lost its shape, and pain wrecks sleep and daily life despite good care. A replacement can work well in that setting. But it is a big operation with a long recovery, and a second surgery to fix a failed one is harder than the first. For people told they are too young, or who want to wait, the years before a replacement are worth using well.

How is shoulder arthritis confirmed?

By the arm first and the film second. We move the shoulder for you. If the arm will not turn outward even when we do all the work, the joint itself is the limit; a weak or torn tendon hurts but lets us take it the whole way. X-rays taken in the right views show the joint space, the bone spur that forms on the lower edge of the ball, and the shape of the socket. An MRI is rarely needed to make this diagnosis.

Stiffness in every direction has two common causes: arthritis and frozen shoulder. The X-ray separates them, because frozen shoulder leaves the joint space looking normal. The neck is checked at the same visit with head turns and arm reflexes, and the joint numbing test described above is used when the exam leaves doubt.

Dr. Padda arrived in the United States without English, the only Brown kid with a turban in St. Louis neighborhoods that were all Black or all white. A child in that position learns to read what people do before what they say. The habit carries into the exam room: watch how far the arm goes and where your face changes, and the scan report becomes a footnote.

When is a painful shoulder an emergency?

• A hot, swollen shoulder with fever or chills. Infection inside a joint can damage cartilage quickly.
• Shoulder or arm pain with chest pressure, sweating or shortness of breath, especially on the left. Call 911.
• Sudden inability to lift the arm after a fall, or a shoulder that looks out of place.
• Pain at the tip of the right shoulder together with upper belly pain or fever. The gallbladder refers pain there.

Ordinary arthritis pain, even severe pain, can wait for a scheduled visit. These cannot.

Frequently asked questions

Do I need a referral to have shoulder arthritis evaluated?

No. Book directly online or by phone. Some insurance plans want a referral on file before they pay for a specialist visit, so check your plan; we can see you either way. What happens at the first appointment.

Can shoulder arthritis cause neck pain?

Yes. A stiff shoulder makes the neck and upper back muscles work harder to lift the arm, and over time they ache too. Treating the shoulder often eases the neck.

Is PRP better than cortisone for shoulder arthritis?

Cortisone works faster. In the trials we have, PRP held its effect longer. Repeated cortisone also carries a cost to cartilage that PRP does not.

What is the best sleeping position for shoulder arthritis?

On your back or on the good side, with a pillow hugged against your chest to support the sore arm. Our sleep position page has more.

Can exercise help shoulder arthritis?

Yes. Gentle range-of-motion work keeps the joint from stiffening further, and strength work for the shoulder blade muscles takes load off the joint. Do not force painful end ranges.

Can PRP help bone-on-bone shoulder arthritis?

It may ease pain, but results are best with some cartilage left. With severe wear we talk through bone marrow concentrate and whether a replacement makes more sense for you.

Related reading

• Neck or shoulder?
• Shoulder pain that starts in the neck
• Rotator cuff, or the neck?
• AC joint pain
• Biceps tendonitis
• PRP and orthobiologics for the neck and shoulder

Show us how high the arm goes and where it stops. We test the shoulder and the neck in the same visit.