Osteoarthritis, a chronic health condition induces high degrees of disability and health costs in all parts of the globe and is presumably very limiting and disabling if the disease manifests at the shoulder joint despite advanced surgical joint replacement and remedial procedures. In this overview, what has been observed in this regard is documented using the PUBMED data base and encompasses a growing body of data extending from very limited reports in 1950 to more than 4800 articles in 2025 where shoulder osteoarthritis works are posted. Adversely impacted, especially in the face of shoulder muscle atrophy, both excess body fat plus the encroachment of excess fatty tissue into vulnerable or injured muscles or tendons it appears only modest progress has been made and most modes of intervention in 2025 focus on surgery rather than non-surgical modes of intervention to mitigate dysfunction, or joint damage. In this regard, we found that with few exceptions and regardless of article examined a possible role for increasing age, inaccurate health beliefs, shoulder muscle fat mass infiltration alongside muscle pain and atrophy may have a strong bearing on shoulder osteoarthritis disability, as may genetics, demographic, cognitions, and occupational factors, thus a multipronged long term tailored approach to care including a plan to prevent shoulder injury, foster innate healing in the face of perpetual reversibility challenges, and education is likely to be worth contemplating.
Keywords: Aging, Osteoarthritis, Pain, Shoulder, Treatment
The disabling joint condition termed osteoarthritis remains a pervasive problem affecting the wellbeing and life quality of a high percentage of older adults wherever they reside and despite years of study and investigation of the many possible causes thereof as well as its potential for palliation or repair. Largely focused on articular cartilage as a key osteoarthritis site of pathology, some of this related research is now alluding to a highly important role for muscle as a disease precursor, modifier or mediator, as well as human behaviors. This includes a specific condition termed sarcopenia denoting muscle wasting, as well as alterations in the desired muscle fat ratio and that consistently features in many osteoarthritis cases, and is possibly enhanced in those who are morbidly obese, where the joint tissues and cartilage lining may be subjected to undue injurious additive or summative micro impacts and aberrant joint forces as well as macro injuries. In addition, morbid obesity if present is associated with higher disability as well as complication rates, prolonged hospital stays, and increased non-routine discharge rates in cases who require shoulder replacement surgery. Additionally, associated muscle volume declines that can manifest with or without obesity presence may have enormous implications for joint stability, joint mobility, joint proprioception and functional wellbeing in the older population along with anatomic factors that may exacerbate shoulder osteoarthritis disability significantly in its own right.1-8
At the same time, a growing body of research points to the desires of many older adults to remain in their own homes and without adequate shoulder function this goal seems impractical at best. Moreover, while muscle as a target for intervention in osteoarthritis including efforts to avert preventable modes of muscle mass declines may be effective, they are rarely mentioned or reinforced in the context of the shoulder joint. Health and mental health as well as health education is also not commonly mentioned as essential even though uncontrolled movements or adaptive strategies may foster pain and a limited physical ability, as well as increased vulnerability to sleep deficits, anxiety, kinesiophobia, and joint macro injuries such as falls. Most common are therapists’ overall agreement that they would offer advice/education; weight management; prescribed or strengthening exercises to improve movement.
Indeed, it is possible osteoarthritis remains a prevalent chronic disease affecting one or more freely moving joints such as the shoulder because its characterisation by progressive bone remodelling, articular cartilage degeneration and soft tissue capsular and ligamentous alterations and interactions are rarely discussed from an etiologic and remedial reversible or preventive perspective. Despite multiple recent reports that focus almost exclusively on various shoulder surgery technique options, such as arthroplasty or joint replacement, and its outcomes, little else is currently highlighted despite a clear need beyond the mechanical procedure and in terms of documenting the complex nature of the surgical need and why repairs may fail or need removal. On the other hand, a focus on muscle, deemed to be deterministically associated with most forms of shoulder osteoarthritis, may represent a possible remediable or preventable intervention pathway for many older adults including mitigation of the encroachment of various degrees of muscle fat, muscle spasm, muscle contractures, muscle fibrosis, inflammation, muscle mass losses, weakness, pain, and pathology all found to be clearly pathogenic shoulder osteoarthritis moderators or mediators as well as possible causative factors. In addition, stem cell research that alludes to tissue regeneration and electrotherapy devices found to foster collagen synthesis and decrease pain may be helpful. Indeed, even if only addressing pain, the impact of careful pain management may offset a host of disabling comorbid degrees of anxiety and depression and self-perceptions of incapability.9
To this end, as per recent reports it appears that in addition to a surgical option, a need exists for employing other strategies, including education, support, information provision, pain management, and due consideration of the emergence or presence of psychosocial10 and metabolic factors, and the negative health impacts due to possible increases in oxidative stress, and inflammation.11 Alternately, more cases may remain unchanged or worse off12 if applied in the absence of careful patient specific analyses and planning,13 the acknowledgement and treatment of possible body mass influences,13 muscle related factors, plus poor overall mental health.14-16 There may be an unexpected emergence or persistence of post-surgical pain,17 possible unabated pain centralization18 and often collective negative overall outcome responses.19
To establish if more could be done in the future to reduce shoulder osteoarthritis disability, we elected to garner some current insights given the immense numbers of at-risk older adults, for example those who work in occupationally stressful settings as far as the shoulder joint is concerned. In particular, not only are anticipated costs incalculable but for older adults who want to remain independent in their own homes a functional shoulder joint is essential. In this regard, it was anticipated the literature would reveal a high number of studies examining non-surgical or drug interventions given that aging adults may be unable to rely on surgery. We also sought to uncover if more might be done in this respect to offer a firmer theoretical basis for understanding the condition in the older adult and validating a more extensive menu of options for clinicians as well as clients, for example by applying the idea that human behaviours, perceptions, and cognitions may guide or explain the extent of any surgical recovery where the surgery is held as a constant.
Drawn largely from the PUBMED, database, the largest medically oriented data base, the overview aimed to provide the interested reader a general view of past work as well as current trends and gaps and opportunities in this regard that might be worthy of further consideration and study, as well as serving as viable applications in the health care field. The focus was on osteoarthritis of the shoulder, often underreported, but a condition accepted as a current challenge and one posing an enormous activity obstacle and deterrent to successful aging goals, including a vastly decreased ability for self-care and possibly immense socioeconomic losses, social isolation impacts, poor life quality and need for assistance. While the world awaits a possible effective intervention approach in this regard, more rather than fewer older adults will be likely to be greatly disadvantaged especially if injured in their earlier years due to occupational or athletic injuries, and falls.
A general update of what we know seems timely, because in terms of public health costs alone, it would be impossible to advance the well-being of so many emerging elders, and especially those suffering from food deprivation, obesity, and metabolic syndrome if only end stage cases are targeted. Indeed, this author sought this information in the belief more should be done to at least better understand the disease origins especially those that are potentially modifiable so as to reduce shoulder osteoarthritis risk or rate of progression. In particular, it appears obesity plays a considerable role and that those who exhibit high muscle fat volumes, as well as those who smoke, who pose multiple post operative as well as non-operative challenges in a significant proportion of cases, regardless of age should be targeted. Unexpectedly, Zhang20 noted adipose tissue-derived therapies, including both cell-based and cell-free products may yet promote cartilage repair and modulate inflammation, thus improving joint function and that should be explored further to examine its ability to minimize the onset of shoulder instability.17
Drawn largely from 2025 data, the ideas embedded in the available 4800 articles posted over the past 75 years, especially the current year 2025 are referred to and assumed to represent the state of the art.
Initiated June 2025, a search covering all data published to date using the key words: older adults, osteoarthritis, shoulder, treatment was undertaken using PUBMED primarily for 2025. Only articles that represented some clinically relevant perspective other than invasive treatments for shoulder osteoarthritis were sought and studied. The specific topic of interest underwent a detailed review, and the points made were those extracted from key recent reports.
It was assumed PUBMED would offer a glimpse into the scope of studies published over the years and would elucidate progress made to date on shoulder osteoarthritis, a disabling condition not often addressed in the osteoarthritis literature. No artificial intelligence was used.
Of the many potentially relevant articles listed, many were too oddly categorized to examine, or were proposals or invasive therapeutic studies. Very notably, most reports consistently describe outcomes of shoulder surgery of different types rather than any other invasive therapy topic or non-surgical approach and almost none highlighted updates on epidemiology or pathogenic perspectives. Also striking is that unlike the literature housed on knee and hip osteoarthritis, very few clinical trials were posted of late, and most reports detailed were retrospective, observational or correlation studies using small samples, assessments conducted with dissimilar measurement tools, methods, unknown measurement properties, and samples largely constituted by ‘young’ rather than older adults.
Very few current works described any major role for artificial intelligence usage and possible robotics and wearable’s as promising therapy adjuncts. None were found when using the search terms ’shoulder osteoarthritis and older adults’ discussed nutrition, comornid health, bone status and any form of electrotherapy, joint stabilization, joint protection, and safe versus unsafe exercise approaches. No matter what the topic, for example shoulder surgical outcomes of which there are many examples, these were generally non uniform procedures and discussed diverse outcome attributes with no true uniformity, were not well designed and well controlled prospective studies, or theory based, and did not distinguish unilateral from bilateral shoulder disease subjects, those with osteoarthritis of other joints, and overall, appeared to focus on the end stages of the disease where pain could not be relieved readily, and may have originated or been perpetuated by shoulder tendon damage that would remain untreated.21 Whether these surgical cases with end stage disease were also receiving conservative approaches was impossible to decipher. Moreover, the degree to which the surgical candidate received pre or post operative education and rehabilitation, was an opioid user or smoker, was obese, and their history was one of a distinct injury versus a slow subtle onset is also hard to discern even though early researchers pointed to this being a complex albeit important disease to unravel and plan for and validate.
As well, simply relying on outcome assessments employed in past years such as standard radiographs may not tell the whole picture. For example, joint replacement procedures may fail especially if no correlation between the subject’s radiographic and histological severity is non-significant when compared to their age. Assessing success but performing no actual functional measures renders the outcome data less than compelling. Similarly, for pain. Additionally, a diagnosis based on pain alone may not direct the sufferer to the appropriate intervention if their pain originates from cervical problems, local tissue damage or muscle fat sources rather than the state of radiographic degeneration. In addition, mental health challenges due to a growing sense of having an ‘incurable ‘condition and possibly the development of a negative body image along with decreased occupational, recreational, and self-care abilities as well as fear of their pending regression are also possibly outcome determinants not dealt with effectively by surgery alone or even assessed.
In sum, it appears if one wants to study shoulder osteoarthritis in the older adult population in real time via traditional sources rather than through artificial intelligence this will prove challenging to the clinician as well as clients. This is because, it appears surgery is the adopted mechanism of choice in this realm in 2025, with few exceptions. Perhaps reporting on the strengths of standard therapies is a given and no need exists to study this, but it is its failure that is most cited as the reason for surgery.
Unfortunately, while surgery is deemed to be cost effective and offers fair results no matter what mode of shoulder surgery is discussed, the intervention applied in isolation may fail to solve all problems, for example those where the shoulder tendons remain torn and there is accompanying muscle fat infiltration and joint instability.21-25 Inflammation25 and other possible influential morphological effects,26-28 sex based differences, and unknown sleep responses are also possible confounders.28,29 An apparent focus in surgical studies on adults younger than 65 years of age may not simulate what would occur in an older adult with no traumatic history.
To advance the field, more comparative studies, including conservative drug free approaches are indicated.30 Screening questionnaires that evaluate a patient's belief in therapy may predict which cases will fail non operative treatment and which may succeed.
Shoulder osteoarthritis, a strong risk factor for persistent shoulder pain in many older adult populations23 has been studied for almost 75 years or more. Yet this form of osteoarthritis while prevalent, and costly, especially among the aging population is not well represented by that age group compared to young adults. Moreover, even in younger adults the underlying pathology and biomechanics of the disease have not been fully elucidated. Very few studies other than those reporting surgical outcomes of end stage-oriented studies prevail in 2025. In addition, advancements attributable to robotic surgery and artificial intelligence are not well covered topics at present.
In is this regard, it is apparent many clinicians believe the disease that emerges in some older adults is similar to that occurring in younger adults, but very few updated studies describing painful shoulder osteoarthritis origins and progression across the lifespan exist to justify this belief. Moreover, why end stage shoulder osteoarthritis - an age-associated disease - occurs in cases under 50 years of age, and why they may largely be males not females, warrants study. As well, how to preserve joint function through means other than surgery, arthroscopy, or some form of injection, is likewise hard to uncover, for example a case for pulsed electromagnetic fields to repair tendon, preserve bone, and decrease inflammation can surely be made.
As a result of these gaps, seniors looking forward to living a meaningful well-earned life who incur shoulder pain may suffer in excess unless a better understanding of the natural history of shoulder osteoarthritis and the role of obesity and possible mental health attributes emerges soon.33 Improvements may also be magnified in the face of surgery.32 Alternately, millions may suffer unduly, especially those less able to secure invasive surgery or undergo one or more of these procedures safely.
In this regard, clinicians are urged to be cautious to do ‘no harm’ because while current reports strongly highlight the degree to which surgery approaches have progressed, not all reports are favorable and the impact on function and neurokinetic alone remains generally unknown. Moreover, until a better sense of why shoulder osteoarthritis pain develops and evolves,34 and diagnostic tools that reflect the state of the art, beliefs the condition is progressive may limit progress. In particular, why conservative interventions do or do not help and examining the mediating roles of cognitive status, disease beliefs, health status, fears, pain, muscle mass composition, and genetics needs attention.
A better understanding of remediable as well as mediating factors that impact the natural history of shoulder osteoarthritis such as obesity and possible mental health attributed may make an enormous difference here, as well as in establishing the basis for holistic rather than simply joint specific remediation, while pointing to the costs of therapies that may prove ineffective.33
In this regard, case studies, and more qualitative research to identify trends and highlight the actual goals of the community dwelling aging adult in 2025 and beyond may reveal what is needed and why. As the likelihood of most adults alive in 2025 surviving to become centurions is increasing markedly, it appears vital researchers from different disciplines work with physicians and theorists as well as policy makers so as to tease out how to avert shoulder osteoarthritis and inadvertent dysfunction more ably and globally for all at low cost. Differentiating shoulder osteoarthritis causes such as those due to traumatic injuries other than sports and work, rotator cuff pathology, shoulder instability or dysplasia, and bone attrition may be especially promising in enabling more targeted and effective early as well as long term outcomes than not as may advance AI based imagery versus standard radiographs.23
Presently, this current mini report remains limited in offering validated clinical protocols due to a lack of data on shoulder osteoarthritis pathology and noninvasive interventions as sought in 2025. The data too present numerous design challenges that preclude aggregation, such as a) no apparent outcome assurances of measurement robustness and sensitivity, b) data collected retrospectively from subjective reports and diverse venues, expert views or chart reviews, c) low quality intervention evidence, and limited sub-group descriptions or analyses.35-37
Moreover, even if the application of scientific modelling explanations for the observed sex difference and outcomes in cause-and-effect interactions that are designed to scale up the ability to predict surgical is laudable, this approach requires follow up.38 The effects of sample size [usually low] plus study sample pathology and unknown influences of heterogeneity factors are not always accounted for in arriving at the conclusions of many standalone or aggregate reports.13,39,40 The fact an adult with no shoulder problem can demonstrate glenoid or shoulder joint attrition is confusing at best and in interpreting studies that rely on radiographs22 as well as being retrospective41 and short-term42,43 or multi centre analyses.44 Sleep quality, often disturbed by shoulder pain is not always assessed as an outcome or measured in a uniform manner, thus the degree to which surgery is valuable is weakened despite its relevance for the validation of shoulder osteoarthritis surgery on life quality.29
In short, much is needed to advance this field and allay suffering. Alternately, Shoulder osteoarthritis will remain a highly disabling costly public health problem affecting many older adults. However, as of July 20 2025, it appears little attention to upstream directed prevention approaches exists. As well, even in younger cases shoulder replacement in its own right can be accompanied by long-term periods of dysfunction and a high revision rate in active cases.44
To avert what seems to be a present significant degree of disease among older adults,45 preventing risky behaviors, addressing mental health challenges, fostering joint protection, strength, and weight management among young and older adults in the community in addition to traditional physical therapy appears promising.48 As well, occupational therapy visits to identify risk or remediable factors in the home or worksite may be helpful. Research to uncover and highlight the confounding factors alluded to previously and most recently articulated by Cohen49 is strongly recommended here. This group reveals a higher incidence of osteoarthritis than reported in the literature that they attributed to the imaging method employed. Preoperatively, they reported risk factors for the presence of osteoarthritis included cases resulting from seizure disorders and larger globoid bone defects that should be explored. Postoperatively, they found the only factors related to the progression of osteoarthritis were those associated with potential surgical technique issues.49
Another group have suggested demographics may play an explanatory role.50 Since injury appears to be strong disease predictor, ensuring sports participation is unlikely to foster shoulder injury, while minimizing excess mid-life weight gain, and mitigating harmful impact loads are similarly promising approaches.51
Some authors point to the possibly of employing some form of personalized genetic profiling,46 accounting for the unique history of the sufferer and their present situation, as well as their personal needs bearing in mind those who are older may be especially disadvantaged as regards inflammation, pain and stress factors.46,47 Long term follow ups are essential as healing may take longer than the time frame assessed for younger adults, and because of potential activity restriction and concerns about glenoid loosening52-60 and an observed decline post-surgery as the adult ages with possible increases in need for revision61 and emergent adverse events including fractures, dislocations, infections, and rotator cuff failure.62
In the interim, since beliefs outweigh facts, making sure what the public perceive is accurate and facts embodies all known facts without artificial intelligence that cannot have clinical interpretative understandings of all is of the highest importance in these researchers view. In particular, congruence between patient and clinician expectations appears to have relevance to outcomes.56
To this end, improving our insights via carefully construed qualitative studies that convey older adult’s life’s experiences using adequate samples of older adults as well as disease features that compliment well designed quantitative approaches applied prospectively as early on as possible in the symptomatic case are urgently needed, as the findings of young cases who appear to have incurred sports or work injuries and want to return to these57 and their disease underpinnings and responses may not correspond with those suffered by older adults. A stronger role of biomechanics, plus a role for unique genes and attempts to uncover underlying biological processes that can predict outcomes and risk may prove helpful as well.54,55,59
Being sensitive to the ecology and need to enhance resource opportunities, retirement agencies, hospitals, community health centers and therapists can help to educate older adults at risk for shoulder osteoarthritis how to be effective osteoarthritis managers,60 while therapists can examine how homes or work sites and work or excess repetitive activities may be adapted to minimize pain and maximize a high degree of function. Families/employers and policy makers can help by solidifying the above and by offering soundly construed tailored and adequate resource support.
Important too is the protection of adults in the home and workplace, more possible emphasis on robotic energy saving applications,53 smoking cessation, the eradication of food insecurity that impacts muscle mass and tissue healing, obesity management20 and intervention practices that align with key demographic factors known to mediate shoulder osteoarthritis in older adults, such as social disadvantage.51
None.
This Research Article received no external funding.
Regarding the publication of this article, the author declares that he has no conflicts of interest.
