Poor Gut Health: An Unexpected Cause of Shoulder Arthritis

Shoulder arthritis: Businesswoman suffering from shoulder pain

Statistics show more than 91 million adults were diagnosed with arthritis in the United States in 2015. Shoulder arthritis occupies a significant portion of those cases. Characterized by chronic pain and limited range of motion, arthritis is the leading cause of physical disabilities today [1].

As standard medicine tends to address a disease’s symptoms rather than the cause, many patients still struggle with chronic shoulder pain. More significantly, only a small handful of patients realize that the root cause of shoulder pain may be due to poor gut health.

In this article, we’ll delve into different forms of shoulder arthritis, their symptoms, and possible treatment options. Then, we’ll explain the link between poor gut health and shoulder arthritis to help you understand why functional medicine may help improve your shoulder arthritis.

What Is Shoulder Arthritis?

Arthritis of the shoulders is characterized by inflammation, pain, and often, a limited range of motion. Let’s take a look at the shoulder anatomy to understand how this may happen.

The bone structures of the shoulder consist of the:

  • Humerus (upper arm bone)
  • Clavicle (collarbone)
  • Scapula (shoulder blade)

Here’s what key joints and soft tissues in the shoulder include:

  • The glenohumeral joint (or glenoid) is the socket connecting the upper arm bone to the shoulder blade (acromion).
  • The acromioclavicular (AC) joint links the collarbone to the tip of the shoulder blade.
  • The rotator cuff is a group of tendons and muscles that holds the upper arm bone in place (i.e., the glenohumeral joint).
  • The articular cartilage is the smooth protective covering of the shoulder bones.

Symptoms of shoulder arthritis generally include:

  • Tenderness, swelling, stiffness, and pain in the front and/or back of the shoulders
  • Crepitus, which refers to creaking, crunching, or grinding noises in the shoulder joint during movement
  • A limited range of motion or loss of motion

Types of Shoulder Arthritis

These are the types of arthritis patients frequently experience:

Rheumatoid arthritis

As an autoimmune disease, rheumatoid arthritis affects multiple joints, including the shoulders. The synovium (a soft joint tissue) becomes inflamed, causing joint pain and even articular cartilage loss [2]. As a symmetrical form of arthritis, it usually causes inflammation in both shoulder joints.

Rheumatoid arthritis may also induce inflammation in the surrounding soft tissues like the bursae (small, fluid-filled sacs). As such, it’s often associated with bursitis, which intensifies shoulder discomfort.


Osteoarthritis of the shoulder is a degenerative joint disease [3], commonly known as wear-and-tear arthritis. The articular cartilage gradually erodes, which causes the bones to rub against each other, leading to shoulder pain and stiffness.

Common risk factors for shoulder osteoarthritis include:

  • Major trauma, like shoulder dislocation
  • Overuse
  • Age
  • Obesity
  • Physical inactivity

In severe cases, healthcare providers may recommend total shoulder arthroplasty (total shoulder replacement) to replace the humerus and glenoid.

Post-traumatic arthritis

Post-traumatic arthritis (PTA) is a form of osteoarthritis that develops after a shoulder injury. PTA usually resolves on its own within 2-3 months. If symptoms persist after six months, it’s categorized as chronic PTA, resulting in chronic osteoarthritis or inflammatory arthritis [4].

Common examples of acute injuries resulting in osteoarthritis are:

  • Fractures and dislocations
  • Shoulder muscle and/or ligament sprains
  • Rotator cuff tears

Sports, accidents, and other similar events usually cause these bone and soft tissue injuries.


Spondyloarthritis is a term for different inflammatory back diseases [5]. Axial spondyloarthritis mainly affects the spine. But peripheral spondyloarthritis can cause swelling in the arms and legs, potentially inciting chronic pain in the front and back of the shoulders. Spondyloarthritis is also a common symptom in inflammatory bowel diseases (IBD).

Spondyloarthritis diseases include:

  • Ankylosing spondylitis (AS)
  • Psoriatic arthritis (PsA)
  • Reactive arthritis (ReA)
  • Enteropathic arthritis (linked to IBD)

Rotator cuff tear arthropathy

Rotator cuff tear arthropathy is a severe form of arthritis. It usually occurs when rotator cuff injuries (like a large tear in the rotator cuff tendon) cause the upper arm bone to rub against the acromion bone. This leads to articular cartilage loss and rotator cuff degeneration. With this condition, most patients experience shoulder pain, swelling, weakness, and a loss of motion.

Avascular necrosis

Avascular necrosis is a medical condition in which a lack of blood flow to the upper arm bone causes bone cells to die. Subsequently, the dead bone collapses on itself. Physical trauma (like a dislocated shoulder), steroid use, and sickle cell anemia can trigger it.

Standard Treatment Options for Shoulder Arthritis

Shoulder arthritis: Hand full of different pills

In standard medicine, non-surgical treatments are often used as the initial treatment for mild to moderate cases of shoulder arthritis. They include:

  • NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen, Aleve (naproxen), and Celebrex (celecoxib).
  • Pain relief medications, like Aspirin and Tylenol (acetaminophen). 
  • Dietary supplements, such as chondroitin and glucosamine.
  • Physical therapy for pain management and relief.

In severe cases, doctors may recommend invasive procedures such as partial or total shoulder replacement surgery.

While conventional treatment options may provide shoulder pain relief, they do not help to resolve problematic shoulder conditions. In fact, some of the treatment options may even contribute to the conditions at the root of inflammatory joint conditions. For example, NSAIDs have been shown to potentially trigger or worsen leaky gut [6, 7] and Crohn’s disease [8, 9, 10] while glucosamine may cause nausea and diarrhea [11].

The Link Between Gut Health and Shoulder Arthritis

In some cases, chronic inflammation in the shoulder joints can be traced back to the gut microbiome [12].

Gut flora imbalances trigger the immune system to create inflammation in other areas of your body besides the gut. In fact, gut dysbiosis is a possible root cause of rheumatoid arthritis [13] and osteoarthritis [14].

These gastrointestinal conditions are commonly associated with arthritis of the shoulders:

  • Small intestinal bacterial overgrowth (SIBO) is linked to rheumatoid arthritis [15].
  • Irritable bowel syndrome (IBS) defines joint pain as one of its clinical symptoms [16, 17].
  • Inflammatory bowel diseases (IBD) are often linked to joint stiffness (for example, frozen shoulders) and spondyloarthritis [18, 19, 20].

If problematic shoulder conditions coincide with digestive issues, poor gut health may be the culprit. In these cases, symptoms-only therapies, like pain relief medications, may be ineffective in helping to fully heal the root cause of chronic shoulder pain.

How Does Functional Medicine Help With Shoulder Arthritis?

Fortunately, functional medicine can help.

Many functional healthcare providers, like the team at Austin Functional Medicine, understand that one root cause may lead to more than one chronic disease. In this situation, an impaired digestive tract is potentially responsible for poor gut health and also non-digestive symptoms like shoulder arthritis.

Moreover, functional doctors create individualized treatment plans tailored to each patient’s unique health needs. Not only can this address the root cause of your shoulder problems for relief and resolution, but it can also optimize your healing progress.

Lastly, functional physicians often work with other healthcare providers for a more successful patient outcome. For example, you may be referred to a physical therapist to learn the best exercises for shoulder pain management. Or, when dietary interventions are used to decrease inflammation, a nutrition coach can help you make lifestyle changes.

Functional Treatment Options for Shoulder Arthritis

Dumbbell and bowl of salad

Unlike conventional medicine, functional medicine prioritizes healthy lifestyle changes over prescription drugs and surgery. It reduces unnecessary reliance on interventions that only provide symptom relief instead of complete resolution of your shoulder problems.

In addition, functional medicine recognizes chronic inflammation as one of the causes of shoulder pain. Using diets, supplements, and lifestyle modifications to reduce gut inflammation may then help alleviate problematic shoulder conditions.

Therapeutic Diets

Current studies on gut ailments associated with joint pain suggest anti-inflammatory diets may be effective for alleviating shoulder arthritis [21, 22, 23].

Elemental diet

The elemental diet resets the gut to tackle bacterial imbalance and help mitigate joint inflammation. Research shows the elemental diet can be just as effective as the anti-inflammatory drug, prednisone, in managing rheumatoid arthritis [24].

Low-FODMAP diet

For patients with IBS and SIBO, a diet high in fermentable carbohydrates feeds the harmful gut bacteria to trigger dysbiosis, which can worsen arthritis of the shoulders. One study found that consuming more sugar-sweetened beverages increases the risk of rheumatoid arthritis [25].

In these situations, a low-FODMAP diet may help improve intestinal health and alleviate non-digestive symptoms like shoulder joint pain [26].

Prebiotics and Probiotics

Prebiotics and probiotics are well-known dietary supplements that promote a more balanced gut microbiome to reduce inflammation, thereby easing chronic shoulder pain. Two human clinical trials have found that probiotics are helpful in rheumatoid arthritis disease activity. However, a third study did not show significant improvements [27, 28, 29].

Anecdotal evidence also showed that the combined use of probiotics, antimicrobials, and the paleo diet completely resolved a patient’s chronic shoulder pain and mild digestive issues.

Not all patients do well with prebiotic supplements. A functional medicine practitioner can help you determine the best approach for you.

Physical Therapy

Physical therapy can be an important intervention for shoulder pain relief. Research supports physical therapy as an effective treatment for improving problematic shoulder conditions like glenohumeral osteoarthritis [30, 31].

To maximize its effectiveness, physical therapy is often paired with other treatment options such as dietary interventions and lifestyle changes.

Lifestyle Changes

Healthy lifestyle changes, such as getting better quality sleep and smoking less [32, 33], may help reduce chronic inflammation to manage shoulder arthritis. Regular physical activity at the appropriate frequency also diminishes fatigue and pain while improving patients’ range of motion [34, 35, 36].

Achieve Shoulder Pain Relief With Austin Functional Medicine

Back and shoulder pain can be a crippling medical condition that affects your quality of life. If you’re plagued by shoulder arthritis and seek no relief from conventional medical treatments, look to functional medicine.

At Austin FM, our team of functional healthcare providers listens to your health concerns and reviews your medical history. This way, we can more accurately determine if poor gut health is the root of your shoulder pain. By providing sound medical advice and creating an individualized treatment plan, we can help resolve your shoulder arthritis for a better quality of life. Book an appointment today to learn more.


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