The articular cartilage in the shoulder can become abnormal and wear away from a variety of causes, including the aging process, injury, instability, prior surgery, infection, and fractures.
X-ray of an arthritic shoulder 
Arthroscopic image of an arthritic shoulder joint 
Arthroscopic image of a cartilage defect in the humeral head 
Arthroscopic image of multiple cartilage loose fragments in an arthritic shoulder 
Arthroscopic image of multiple large bony loose bodies in an arthritic shoulder
Conservative treatment options include medications, periodic injections, and physical therapy. On occasion, when the arthritis is not severe and when there are specific modifiable and concomitant problems ( loose bodies, labral tears, biceps tendon tears, and motion restriction ), an minimally invasive arthroscopic procedure can be considered. Arthritis, however, is the loss of cartilage, and this cannot be reversed. Conservative and minimally invasive procedures are then only designed to treat the symptoms of the arthritis, and not cure the arthritic condition. When a patient develops disabling symptoms as a result of arthritis, a joint replacement can be considered. Shoulder replacements have improved with new generation implants, better imaging and instrumentation, and can now be considered a long-term solution for patients that develop severe pain and dysfunction in their shoulder. CT scans of the shoulder and newer computer software now allows for 3D modeling and patient specific instrumentation for precise implant placement. For some patients, only the humerus or “ball” of the shoulder is replaced or resurfaced. This is called a hemiarthroplasty. For most, a total shoulder replacement, which involves replacing the humeral head or “ball” with a metallic implant and the glenoid or socket, with a plastic socket, is an option to improve pain, motion, and function.
 Stemless Total Shoulder Arthroplasty |  Anatomic Total Shoulder Arthroplasty |
For others, particularly those with severe deformities, severe fractures, torn or poorly functioning rotator cuff tendons, and those that have failed a previous joint replacement, a reverse shoulder replacement is probably a better option to consider. In the reverse shoulder, the glenoid or socket, is milled down and a metal ball is secured to it. On the humeral head side, or ball side, the head is reamed out and a socket is fixed in place. Thus, a backward or reverse shoulder.
