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Shoulder Arthritis Overview

Affecting nearly 60 million people in the US alone, arthritis is considered a leading cause of disability in the country and worldwide. This is an inflammatory, chronic condition of the joints, which occurs when ongoing raised levels of inflammation begin to damage tissues – such as the lining of the joint capsule (synovial membrane), the cartilage, and the bones.

Over 100 types of arthritis have been identified. Some, like rheumatoid arthritis, are autoimmune diseases that develop when the immune system mistakenly attacks healthy tissues in the body. Others, like osteoarthritis, occur due to age-related wear and tear of the cartilage, as well as overuse and excessive stress on the joints.

The shoulder can be affected by several forms of arthritis, including:

  • Rheumatoid arthritis
  • Osteoarthritis 
  • Posttraumatic arthritis
  • Rotator cuff tear arthropathy (arthritis that develops following a rotator cuff tear)
  • Osteonecrosis or avascular necrosis (a form of arthritis that occurs when the blood supply to the shoulder joint is cut off)

Shoulder arthritis can affect one or more parts of the shoulder:

  • The glenohumeral joint: The ball-and-socket joint located at the back of the shoulder that connects the head of the humerus (the arm bone) to the scapula (shoulder blade)
  • The acromioclavicular (AC) joint: The joint located at the top of the shoulder, which connects the acromion (outer edge of your scapula) with the clavicle (collar bone)

Depending on which joints are affected, your symptoms may be localized to only one area of the shoulder. Conditions like rheumatoid arthritis will progress into affecting both joints and causing widespread pain.

Shoulder arthritis can stem from a combination of risk factors. These include:

  • Age-related degeneration of the cartilage 
  • Shoulder injuries (e.g. fractures and dislocations) that change the shoulder’s structure and mechanics
  • Overuse and excessive, repeated stress, often caused by repetitive or forceful shoulder movements
  • Being female (due to the stronger immune system and the drop of inflammation-fighting estrogen levels that occurs during menopause)
  • Genetics and hereditary factors, such as having thin cartilage
  • Poor posture and abnormal shoulder mechanics, which cause the cartilage to wear down unevenly


Symptoms Of Shoulder Arthritis

The symptoms of shoulder arthritis are bound to change in nature and intensity over time and worsen alongside the progression of the disease.

At first, arthritis of the shoulder causes pain, stiffness, and discomfort, which may prevent you from lifting your arm fully. Over time, the damage caused to cartilage, ligaments, tendons, and bones may be so severe as to prevent you from carrying out simple activities like brushing your hair.

The most common symptoms of shoulder arthritis include:

  • Pain in the shoulder, either localized around the joint affected or widespread. Over time, painful sensations may begin to radiate to the arm, elbow, and wrist. 
  • Pain that intensifies during or after movements, such as lifting or carrying heavy objects. 
  • Stiffness and swelling, caused by the inflammatory response. This can further reduce your range of motion and impact your ability to move your arm. Stiffness tends to intensify after periods of inactivity, such as in the morning after waking up. 
  • Crepitus, which refers to grinding, cracking, or clicking noises felt during shoulder movements. You may also experience sensations such as if your shoulder would “lock up.” 
  • Reduced range of motion, caused by the impact of arthritis on the shoulder mechanics. Over time, you may find that you are no longer able to perform movements like lifting your arm over your head or reaching to pick up items on a higher shelf.


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Conventional Treatment Options

With over a quarter of the US population experiencing chronic shoulder pain, there’s little doubt about the fact that this condition is extremely widespread. But besides being common, shoulder conditions are incredibly impactful.

The symptoms of arthritis also trigger a cascade of life-limiting consequences, such as compromising your employability and your ability to continue living independently as you age. The perception that there is no effective cure for this disease can also aggravate the picture, and lead to mental health issues such as depression, anxiety, and social withdrawal.

Below, we’ll look at the most common treatments prescribed for shoulder arthritis.

Corticosteroid Injections

Corticosteroids are a class of drugs that uses the synthetic version of a chemical already naturally produced by the body, called cortisol, which is responsible for inhibiting inflammation and regulating the perception of pain.

Corticosteroid injections are based on crystals containing cortisol. When injected into the site of injury, these crystals release cortisol over time, producing a longer-lasting pain-relieving effect compared to other medications.

Although corticosteroids are widely used in the management of arthritis, new studies have started to uncover the side effects of this line of treatment. Firstly, taking corticosteroids regularly can cause the dysfunction of the adrenal glands, which are the organs that naturally produce cortisol in the body. Additionally, corticosteroids may speed up the degeneration of cartilage and the progression of arthritis.


NSAIDs, which stands for “non-steroidal anti-inflammatory drugs,” are a class of drugs that work by blocking the cyclooxygenase (COX) enzyme, which is responsible for the production of the chemicals that trigger inflammation in the body (prostaglandins).

By inhibiting the release of prostaglandins, NSAIDs can temporarily stop the inflammatory response and, in turn, the associated pain, swelling, inflammation, and stiffness. 

Given that NSAIDs like ibuprofen, naproxen, or celecoxib are available as over-the-counter alternatives, around 30 million Americans use them regularly to manage chronic pain. However, the ongoing use of these medications can lead to several side effects that should not be overlooked, including increased risk of heart attack and stroke, stomach ulcers, kidney dysfunction, and addiction.


Arthroscopy is a form of minimally invasive surgery that can be used to manage mild cases of shoulder arthritis. During this operation, the surgeon will insert a thin instrument (arthroscope) with an attached camera into the shoulder joint through a small incision.

Using the images provided by the camera, the doctor can use this surgery to diagnose shoulder problems and carry out minor surgical repairs, such as mildly reshaping bones or cleaning out the inside of the joint.

Arthroscopy may offer temporary relief from pain, but this surgical intervention does not reverse arthritis, nor does it prevent further disease progression.


Arthroplasty – or shoulder joint replacement – is a far more invasive surgical alternative required in severe cases of arthritis. It is prescribed when the disease has severely damaged tissues such as bones, ligaments, and tendons, and is now causing disability.

Arthroplasty involves reshaping bones and replacing one or more components of the shoulder joint with artificial implants, usually made of metal or plastic.

Depending on what compartment of the joint has been affected by arthritis, there are several types of arthroplasty that may be recommended. These include:

  • Hemiarthroplasty: This involves replacing the head of the humerus (the top of the arm bone) with an artificial component.
  • Total shoulder arthroplasty: The entire shoulder joint is replaced by artificial components
  • Resection arthroplasty: Part of the damaged joint is removed, and the space is eventually filled by scar tissue.
  • Reverse total shoulder arthroplasty: In this type of surgery, artificial joint components are used to replace the “ball-and-socket” of the shoulder joint. However, the implants are placed oppositely to normal anatomy. The “socket” is placed at the top of the arm, which usually houses the “ball”, and vice-versa, the “ball” is placed on the side of the scapula (on the glenoid), which, in normal anatomy, is the “socket” of the shoulder joint.

What Is Platelet-Rich Plasma (PRP)?

Platelet-Rich Plasma (PRP) refers to samples of the patient’s own blood (autologous blood), which is processed to contain far higher concentrations of platelets compared to baseline values.

The platelets are components of the blood that play a vital role in supporting the repair and regeneration of injured tissues. They do so by clotting (or coagulating) the blood to prevent excessive bleeding when blood vessels are damaged.

A perhaps even more important benefit of platelets is their high concentrations of growth factors. Contained within the platelets in “packets” called alpha granulate, growth factors are proteins capable of:

  • Stimulating the proliferation of cells with the function of repairing damaged tissue
  • “Calling to action” repair cells from across the body to the site of injury.

Put simply, growth factors are like “espresso shots” that stimulating repair cells. PRP, which is rich in platelets, consequently provides high concentrations of growth factors, which can be applied in an easy and non-invasive way to the injury site.


PRP For Shoulder Arthritis

The high concentrations of blood’s growth factors in PRP enhance the body’s ability to repair itself, making platelet-rich plasma injections a form of regenerative medicine. In particular, in regenerative orthopedics, PRP can be used in the treatment of arthritis, as well as muscle strains, ligament or tendon tears, and joint instability.

Today, over 30 randomized trials are available showing the beneficial effect of PRP in helping the body repair itself by stimulating the stem cells within the site of injury.

When used to treat shoulder arthritis, PRP works by encouraging the regeneration of damaged cartilage and preventing disease progression. According to a 2022 study, PRP injections are able to provide better pain relief and functional outcomes than other treatments, including corticosteroid injections. The same study also shows that, compared to other interventions, PRP has a greater capacity to improve shoulder-related quality of life.

A 2019 study that investigated the efficacy of PRP injections and corticosteroids in the treatment of shoulder arthritis shows that the former is far superior in improving pain and reducing inflammation.

In the treatment of arthritis affecting the shoulder’s glenohumeral (GH) joint, 2020 research shows that PRP has offered promising results. This is especially true when comparing PRP to other treatment options like corticosteroids and painkillers, which show only moderate and short-term effectiveness.

Why Are Orthagenex PRP Injections Superior?

So far, we’ve looked at how PRP represents a superior alternative to NSAIDs and corticosteroids in the treatment of shoulder arthritis, and how it can help reduce the risk of surgery. However, not all PRP injections are created equally – nor do they offer the same outcomes. 

At Orthagenex, our mission is to achieve full patient satisfaction by offering superior, customizable, and result-focused PRP injections. To do so, we us a cutting-edge PRP injection procedure, a high-dose PRP injectates.

High-dose PRP injectates are created in state-of-the-art cellular lab environments and delivered with precision using image guidance by a team of highly trained physicians. Thanks to this protocol, injectates used at Orthagenex are far purer, more concentrated, and more customizable to each patient’s needs than standard injections.

Here’s what makes the high-dose PRP different:

Image-Guidance To Place PRP Solutions

Studies show that not using imaging guidance can lead to even trained physicians missing the target location for injections. Nonetheless, in the US, most orthopedic clinics offering PRP perform blind injections, i.e. without any form of image guidance. Furthermore, clinics that do use image guidance often lack the support of an expert team of physicians trained in interpreting results.

But when it comes down to restoring your shoulder health, nothing should be left to chance. That is why, at Orthagenex, we use the most advanced imaging guidance techniques available to reduce reliance on tactile sensations and ensure needle placement accuracy. These techniques are:

  • Ultrasound guidance: This technique uses ultrasound waves to provide physicians with real-time images of the position of the needle from the moment it enters the skin. 
  • Fluoroscopy: Using a C-shaped arm, fluoroscopy provides real-time X-ray images of the needle locations during PRP injections.

Not only are these techniques used in combination at Orthagenex, but they are also performed by highly trained physicians who are experts in interpreting results.

Interventional Orthopedics

Thanks to the contributions made by our team and the results achieved, the use of imaging guidance in PRP is today recognized as a new medical specialty – interventional orthopedics – based on three key pillars:

  • The use of injectates to support the body’s ability to heal musculoskeletal tissues
  • The use of imaging guidance to ensure needle placement accuracy
  • The continuous development of tools and techniques to achieve always better outcomes

Lab-Processed For Higher Concentrations Of Platelets

To achieve the unparalleled levels of purity and the exceptional concentrations of growth factors of Super Concentrated Plasma, Orthagenex uses a proprietary, state-of-the-art cellular lab environment.

This is in stark contrast with the protocols followed by most clinics offering PRP. Especially in the US, the standard procedure used by orthopedic clinics involves using a simple centrifuge (spinning machine) to create the injectate at the bedside.

The patient’s blood is collected and processed using the centrifuge, which separates the platelets from other components of the blood. The resulting mixture is then immediately injected into the site of injury.

While this procedure is common, the centrifuge machines used are not efficient in concentrating platelets, nor are they able to remove impurities and unfavorable cells from the resulting mixture.

In contrast, Orthagenex uses a dedicated lab platform and more advanced instruments to ensure that each injection of PRP is pure, hyper-concentrated, and customized to the patient’s needs.

Here’s how Orthagenex compares:

Other Clinics Orthagenex
Tools used to create PPR Standard bedside centrifuges Specialized flexible lab platform
Protocol to perform PRP Immediately injected to the site of injury The blood samples are sent to an in-house cellular lab environment. Here, unfavorable components are removed and the injectate is customized to the patient’s needs.
Resulting concentration of platelets in PRP Maximum 2-5 times higher than “normal blood” values (2-3 times on average) 10-30 times higher than “normal blood” values

Amber PRP vs. Red PRP


There are two main types of PRP:

  • Red PRP: Red PRP (leukocyte-rich PRP or LR-PRP) contains white and red blood cells, as well as concentrations of platelets. 
  • Amber PRP: Amber PRP (leukocyte-poor PRP or LP-PRP) contains low levels of white and red blood cells and high levels of platelets.

Both mixtures – illustrated above – have high concentrations of platelets, but the outcomes they offer are dissimilar.

Red PRP, which is often the result of using standard bedside centrifuge machines, does offer benefits, including supporting the repair of damaged tissues. However, according to lab tests conducted at Orthagenex, the white and blood cells contained in these mixtures also have counteractive effects. Firstly, they cause inflammation at the site of injury. Secondly, they have an inhibiting effect on the same stem cells that the PRP is attempting to stimulate.

On the other hand, purer amber LP-PRP isn’t pro-inflammatory and offers a more stimulating effect on stem cells. Given these results, amber LP-PRP is the injectate of choice at Orthagenex.

Next-Generation Platelet Lysate

Aside from platelet-rich plasma, Orthagenex also offers platelet lysate (PL) injections. PL is a more advanced form of PRP, which, depending on the patient’s needs, can be used alongside or instead of platelet-rich plasma.

Here are the key differences between PRP and PL:

Growth factors are released over time – usually a week – to the site of injury. Growth factors are released immediately and en masse.
May cause some degree of inflammation. It is remarkably anti-inflammatory
May not be as suitable to treat sensitive areas Suitable to treat areas around nerves and the spinal cord.

Standard orthopedic clinics across the US are just starting to introduce PL injections into their procedures. By contrast, the team at Orthagenex has been taking advantage of this treatment option for years, and we can now offer the third and fourth generations of PL injections. At the same time, our specialists continue to work to increase the purity, concentration levels, and outcomes of this treatment.

PRP Customized To Every Patient’s Need

Certainly, shoulder arthritis causes pain, discomfort, and reduced range of motion. But the nature and intensity of the symptoms of this disease – as well as its impact on a person’s life – varies from one patient to another. Because of this, using a one-size-fits-all approach for all patients is highly inefficient.

At Orthagenex, our mission is to create tailored treatment programs that reflect the unique challenges and goals of each patient. To achieve this, we leverage the potential of our flexible lab platform, as well as additional therapies like bone marrow concentrate.

Solutions Are Customized Using A Lab Platform

Although there’s no doubt about the effectiveness of PRP in the treatment of shoulder osteoarthritis, not all platelet-rich plasma injections are the same. Those procedures that use standardized machines (such as bedside centrifuges) and protocols are not equally efficient for all patients.

Thanks to the Regenexx flexible lab platform, Orthagenex is able to provide a more customized approach. Our specialized physicians perform proprietary lab processing techniques to ensure that each injectate is pure and entirely tailored to the treatment of shoulder arthritis.

Bone Marrow Concentrate (BMC) Can Be Used

Besides PRP, Orthagenex also offers BMC injections, which can be performed alongside platelet-rich plasma injections.

BMC refers to samples of the liquid part of the bone marrow, collected through a small tunnel into the bone, usually near the pelvis. BMC is exceptionally rich in stem cells, which, when delivered to the site of injury, will stimulate and amplify the activity of the repair cells in the areas of need.

Similarly to PRP, BMC can support the repair of injured tissues and support the body’s ability to regenerate damaged cartilage.

Doctors Specializing In Interventional Orthopedics

Besides cutting-edge lab techniques and machinery, Orthagenex leverages the knowledge and expertise of a team of specialized physicians.

All of our doctors are musculoskeletal (MSK) specialists and experts in imaging guidance techniques. The physicians in our team are also all board-certified and also fellowship-trained in interventional orthopedics.

Core Competencies

  • The use of imaging guidance techniques to ensure accurate needle placement
  • The availability of a state-of-the-art flexible lab platform to customize each PRP injection
  • A team of experts specialized in interventional orthopedics
  • Offering purer and more concentrated amber LP-PRP injections
  • Providing additional therapies such as bone marrow concentrate (BMC) and platelet lysate (PL)
  • Using the four-part SANS: a proprietary method of diagnosis and evaluation of chronic pain conditions

Some patients suffering from chronic pain are not able to obtain a clear diagnosis of their condition, nor do they have a clear understanding of what’s causing their pain. While chronic pain isn’t easy to diagnose, the current lack of ad hoc evaluation tools often leads to patients enduring the side effects of undertreatment.

That is why at Orthagenex we have incorporated the SANS (Stability, Articulation, Neuromuscular, and Symmetry) method. This is an innovative method for the evaluation and diagnosis of joint instability.

Thanks to this approach, the physicians at Orthagenex are able to precisely diagnose the location, source, and extent of pain and inflammation. Not only does this create a more accurate clinical picture, but it also provides guidance to choose the best treatment option available.

Orthagenex – Your Alternative To Shoulder Arthritis Surgery

Shoulder arthritis is an extremely debilitating, life-limiting condition. However, enduring the side effects of medications or surrendering to the fact that you’ll spend every day battling chronic pain should not be seen as the only options available.

Thanks to the Orthagenex approach based on superior PRP injections, you’ll be able to stimulate your body’s ability to heal, reverse disease, and magnify your quality of life.

Tired of shouldering the burden of chronic pain? Get in touch with Orthagenex and take the first step towards optimal musculoskeletal health


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