NON-SURGICAL Shoulder Arthritis Treatment in Raleigh & Cary, NC

Shoulder arthritis can make everyday activities increasingly difficult. Reaching overhead, getting dressed, lifting, exercising, sleeping on the affected side, playing golf or tennis, and even simple tasks such as reaching into a cabinet can become painful as the shoulder joint deteriorates.

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For patients with advanced symptoms, shoulder replacement surgery may eventually be recommended. However, not every patient with shoulder arthritis needs—or is ready for—shoulder replacement surgery.

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At Carolina Nonsurgical Orthopedics, we specialize in evaluating patients who want to understand their nonsurgical shoulder arthritis treatment options before considering joint replacement. Depending on the severity of arthritis, symptoms, imaging findings, health history, previous treatments and goals, options may include rehabilitation, activity modification, image-guided injections and orthobiologic treatments such as platelet-rich plasma (PRP), SuperPRP+ with hyaluronic acid (HA), and MFAT cell therapy.

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Our physicians use diagnostic imaging and ultrasound guidance when appropriate to help determine the source of a patient's shoulder pain and whether a nonsurgical treatment strategy is reasonable.

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The goal is not to promise that shoulder replacement can always be avoided. Instead, our goal is to determine whether there are reasonable treatment options to reduce pain, improve function and potentially delay surgery in appropriately selected patients.

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What Is Shoulder Arthritis?

Shoulder arthritis occurs when cartilage within a shoulder joint becomes damaged or progressively wears down.

The shoulder actually contains several articulations, but arthritis most commonly affects the glenohumeral joint, where the head of the humerus meets the glenoid portion of the shoulder blade.

Healthy cartilage allows these surfaces to move smoothly against one another. As cartilage deteriorates, the joint can become inflamed, stiff and painful.

Common symptoms include:

• Deep aching shoulder pain

• Pain with reaching or lifting

• Progressive loss of shoulder motion

• Difficulty reaching behind the back

• Pain while sleeping

• Grinding, clicking or catching

• Difficulty exercising or playing sports

• Reduced ability to perform work or household activities

Patients with these symptoms can learn more about the broader causes of shoulder pain on our Shoulder Pain Treatment page.

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What Causes Shoulder Arthritis?

Several different forms of arthritis can affect the shoulder.

Osteoarthritis is the most common degenerative form. Cartilage gradually deteriorates over time, although previous injuries and genetics can influence how quickly this occurs.

Post-traumatic arthritis may develop after a fracture, dislocation or other significant shoulder injury.

Inflammatory arthritis, including rheumatoid arthritis, can also damage the shoulder joint and generally requires management of the underlying systemic inflammatory condition.

Another important condition is rotator cuff tear arthropathy, in which a large chronic rotator cuff tear contributes to progressive changes in the mechanics and structure of the shoulder.

Because treatment differs considerably among these conditions, determining the actual cause of shoulder pain is important before deciding whether an injection or other procedure is appropriate.

Patients with suspected tendon involvement can also read about our approach to nonsurgical rotator cuff tear treatment.

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How Is Shoulder Arthritis Diagnosed?

Evaluation generally begins with a history and physical examination.

We assess shoulder motion, strength, location of pain, tenderness and the movements that reproduce symptoms. We also look for evidence that pain may be coming from the rotator cuff, biceps tendon, AC joint, cervical spine or another structure rather than primarily from glenohumeral arthritis.

X-rays are particularly useful for evaluating arthritis because they can demonstrate:

• Joint-space narrowing

• Bone spurs

• Changes in the shape of the humeral head or glenoid

• Subchondral bone changes

• Advanced joint degeneration

Diagnostic ultrasound can provide additional information about the rotator cuff, biceps tendon, bursae and other soft tissues.

Learn more about our use of orthopedic X-ray and diagnostic ultrasound.

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Do You Need Shoulder Replacement for Shoulder Arthritis?

Not necessarily.

The presence of arthritis on an X-ray does not automatically mean a patient needs shoulder replacement surgery.

The decision depends on several factors, including:

• Severity of arthritis

• Amount of pain

• Loss of motion

• Effect on daily activities

• Age and activity level

• Overall health

• Rotator cuff integrity

• Previous treatments

• Patient goals

Some patients have significant radiographic arthritis but remain surprisingly functional. Others have more moderate imaging findings but substantial pain.

This is one reason we believe treatment should focus on the patient rather than the X-ray alone.

For patients who are not ready for replacement—or whose arthritis has not progressed to the point where replacement is clearly necessary—it may be reasonable to consider nonsurgical treatment first.

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Alternatives to Shoulder Replacement Surgery

The appropriate treatment plan depends upon the individual patient.

Initial treatment may include activity modification, therapeutic exercise, physical therapy and medications when medically appropriate.

When these measures are insufficient, image-guided injection procedures may be considered.

At Carolina Nonsurgical Orthopedics, regenerative and orthobiologic options for selected patients may include:

• PRP injections

• SuperPRP+ combining PRP and hyaluronic acid

• MFAT cell therapy

These treatments are not substitutes for shoulder replacement in every patient. Their potential role is greatest when a patient still has a reasonable opportunity to improve without surgery.

 

PRP for Shoulder Arthritis

Platelet-rich plasma, commonly called PRP, is prepared from a patient's own blood.

The blood is processed to concentrate platelets and associated signaling proteins. The resulting PRP is then injected into the targeted orthopedic structure.

PRP has become an increasingly important treatment in nonsurgical orthopedics, particularly for osteoarthritis and chronic tendon disorders.

The evidence supporting PRP is strongest for certain conditions such as knee osteoarthritis. Research specifically involving glenohumeral shoulder arthritis is less extensive, so expectations should be individualized rather than assuming results will be identical to those seen in the knee.

For appropriately selected patients with shoulder arthritis, the objective of PRP treatment is generally to reduce symptoms and improve function, potentially allowing a patient to remain active without immediately progressing to surgery.

PRP does not create a new normal shoulder joint, and we do not tell patients that PRP can guarantee avoidance of shoulder replacement.

 

Why We Use Ultrasound Guidance for Shoulder PRP

The shoulder contains numerous structures within a relatively small area.

The glenohumeral joint, rotator cuff tendons, subacromial bursa, AC joint and biceps tendon are all potential sources of pain.

When performing a targeted injection, accuracy matters.

Our physicians use diagnostic and interventional ultrasound when appropriate to visualize the anatomy and guide the needle toward the intended treatment location.

Ultrasound can also help identify additional pathology that may influence treatment.

For example, a patient believed to have isolated shoulder arthritis may also have significant rotator cuff disease. Treating the joint without recognizing the tendon problem may not adequately address the patient's symptoms.

 

SuperPRP+ With Hyaluronic Acid for Shoulder Arthritis

For selected arthritis patients, another option we may consider is SuperPRP+, which combines concentrated PRP with hyaluronic acid.

Hyaluronic acid is a naturally occurring component of joint fluid and cartilage. Injectable hyaluronic acid products have been used extensively for osteoarthritis, particularly in the knee.

PRP and HA work through different proposed mechanisms.

PRP provides concentrated platelets and signaling proteins, while hyaluronic acid is intended to improve the joint environment and provide viscosupplementation.

Combining the two provides a strategy that targets arthritis differently than either treatment alone.

At Carolina Nonsurgical Orthopedics, our SuperPRP+ approach combines PRP with HA for appropriately selected patients when we believe the combination makes clinical sense.

This does not mean every patient with shoulder arthritis needs HA added to PRP, nor does it mean the combination has been proven to prevent shoulder replacement.

Instead, it provides another nonsurgical option that can be considered based on the severity of arthritis, prior treatments and individual goals.

Learn more about SuperPRP+ treatment.

 

PRP + HA vs Cortisone for Shoulder Arthritis

Corticosteroid injections are commonly used for painful shoulder arthritis because they can reduce inflammation and provide relatively rapid pain relief.

There are circumstances where a steroid injection is appropriate.

However, repeated corticosteroid injections are not necessarily the preferred long-term strategy for every patient with chronic degenerative joint disease.

PRP and SuperPRP+ represent a different treatment philosophy.

Rather than primarily using a corticosteroid to suppress inflammation, orthobiologic treatments attempt to use components derived from the patient's own body as part of a biologically oriented treatment strategy.

Neither approach guarantees improvement.

For patients primarily seeking a longer-term nonsurgical strategy rather than another temporary steroid injection, discussing PRP or PRP combined with HA may be reasonable.

 

MFAT Cell Therapy for Shoulder Arthritis

For selected patients with more significant arthritis, we may also discuss MFAT cell therapy.

MFAT stands for microfragmented adipose tissue.

A small amount of the patient's own adipose tissue is obtained and processed before being placed into the targeted area.

Adipose tissue contains a complex mixture of cells, extracellular matrix and signaling components.

MFAT is sometimes casually referred to as a "stem cell" procedure. We prefer to describe the treatment accurately as microfragmented adipose tissue rather than suggesting that it is an FDA-approved stem cell treatment capable of regenerating a new joint.

MFAT does not reliably regrow lost shoulder cartilage, and patients should be cautious of clinics promising that a stem cell injection can rebuild a severely arthritic shoulder.

Our objective is considerably more realistic: improving pain and function in appropriately selected patients using a nonsurgical orthobiologic strategy.

 

PRP vs SuperPRP+ vs MFAT for Shoulder Arthritis

There is no single orthobiologic treatment that is automatically best for every arthritic shoulder.

PRP

PRP may be considered when we believe a concentrated platelet-based treatment is appropriate based on the degree of arthritis and the patient's clinical presentation.

SuperPRP+ With HA

SuperPRP+ adds hyaluronic acid to PRP and may be considered when we want to combine an orthobiologic treatment with viscosupplementation.

MFAT

MFAT may be discussed in selected patients with more substantial degenerative disease or when the clinical situation leads us to consider an adipose-derived orthobiologic treatment.

The decision should not be based simply on choosing the most expensive or aggressive procedure.

We consider the patient's:

• X-rays and other imaging

• Degree of cartilage loss

• Rotator cuff integrity

• Age

• Activity level

• Previous injections

• Previous surgery

• Overall health

• Treatment goals

Sometimes the best recommendation is PRP. Sometimes we may discuss SuperPRP+ or MFAT. And sometimes the severity of arthritis makes a surgical consultation more appropriate.

 

Can PRP or MFAT Help You Avoid Shoulder Replacement?

This is one of the most important questions patients ask.

The most accurate answer is:

Possibly in selected patients—but no injection can guarantee that shoulder replacement will never be necessary.

Shoulder arthritis is generally a progressive structural condition. PRP, HA and MFAT should not be marketed as cures for advanced osteoarthritis.

However, there is an important difference between curing arthritis and helping a patient manage an arthritic joint successfully.

If a nonsurgical treatment provides meaningful pain reduction and improved function, a patient may be able to remain active without immediately proceeding to replacement.

For a 50- or 60-year-old patient who can function well after nonsurgical treatment, delaying an operation may have considerable value.

For an older patient with severe bone-on-bone arthritis, major loss of motion and substantial disability, replacement may ultimately provide a more predictable outcome.

That distinction is why proper patient selection matters.

 

What Is Recovery Like After PRP for Shoulder Arthritis?

One potential advantage of an office-based orthobiologic procedure is that it generally does not involve the prolonged postoperative recovery associated with shoulder replacement.

However, PRP is not an instant treatment.

Patients may experience temporary soreness following the procedure. We typically recommend modifying strenuous shoulder activity initially and then gradually returning to normal exercise and strengthening based on symptoms and the specific treatment performed.

Improvement following PRP generally develops over weeks rather than days.

The exact recovery plan depends on whether we are treating only the arthritic joint or also addressing associated tendon pathology.

Patients considering PRP should understand that the goal is not simply to receive an injection and immediately return to unrestricted activity. Appropriate rehabilitation and progressive loading remain important.

H2: What If Shoulder Arthritis Occurs With a Rotator Cuff Tear?

This is an important distinction.

Shoulder arthritis does not always occur in isolation.

Some patients also have rotator cuff tears, biceps pathology or other shoulder abnormalities.

A major chronic rotator cuff tear can significantly alter shoulder mechanics and may eventually produce rotator cuff tear arthropathy.

This can change both the nonsurgical treatment plan and the type of shoulder replacement that might eventually be considered.

Diagnostic ultrasound and other imaging can therefore be particularly helpful when determining whether symptoms are primarily coming from the arthritic joint, the rotator cuff or both.

 

When Is Shoulder Replacement the Better Option?

Our practice specializes in nonsurgical orthopedics, but that does not mean surgery should always be avoided.

Shoulder replacement may be appropriate when there is:

• Severe joint destruction

• Persistent pain despite appropriate nonsurgical care

• Major loss of shoulder motion

• Significant limitation of daily activities

• Severe nighttime pain

• Progressive deformity

• Rotator cuff tear arthropathy

• Inadequate response to reasonable nonsurgical treatment

Modern shoulder replacement can provide substantial pain relief and functional improvement in properly selected patients.

The goal of nonsurgical treatment should therefore be to avoid unnecessary or premature surgery—not to avoid necessary surgery at all costs.

 

Why Consider Carolina Nonsurgical Orthopedics for Shoulder Arthritis?

Carolina Nonsurgical Orthopedics focuses on orthopedic conditions that may be treated without surgery.

Our approach to shoulder pain includes identifying the specific pain generator, reviewing imaging and considering the full spectrum of nonsurgical treatment options.

Depending on the patient, that may include:

• Diagnostic ultrasound

• Image-guided injections

• PRP therapy

• SuperPRP+ with HA

• MFAT cell therapy

• Shockwave therapy for appropriate associated tendon disorders

• Rehabilitation recommendations

• Referral for surgical evaluation when appropriate

Our goal is to provide patients with a realistic assessment of what can—and cannot—reasonably be accomplished without surgery.

 

Shoulder Arthritis Treatment in Raleigh & Cary, NC

If shoulder arthritis is interfering with sleep, exercise, work, golf, tennis or normal daily activities, you may have options before shoulder replacement surgery.

Carolina Nonsurgical Orthopedics provides nonsurgical shoulder arthritis evaluation and treatment in Raleigh and Cary, North Carolina, including ultrasound-guided procedures and orthobiologic treatments for appropriately selected patients.

Patients interested in avoiding or delaying shoulder replacement can learn more about:

Shoulder Pain Treatment | PRP Injections | SuperPRP+ | MFAT Cell Therapy | Rotator Cuff Tear Treatment | Orthopedic X-Ray & Ultrasound

Contact Carolina Nonsurgical Orthopedics to schedule an evaluation and determine whether PRP, SuperPRP+ with HA, MFAT, or another nonsurgical treatment may be appropriate before considering shoulder replacement.