Low-Dose Radiation Therapy for Shoulder Osteoarthritis

Low-dose radiation therapy (LDRT) is an outpatient treatment that aims a very small amount of radiation at an arthritic joint to calm inflammation in the joint lining. The shoulder is one of the joints programs most often discuss LDRT for, alongside the knee, hands, and hips. Major centers including Cleveland Clinic, UAB, Hackensack Meridian, and St. Mary's Medical Center all list the shoulder among the joints they treat with LDRT.

Shoulder osteoarthritis can be especially limiting: reaching overhead, dressing, and sleeping on the affected side all become painful. When medications, cortisone injections, and physical therapy stop being enough, patients are usually told the remaining options are living with it or shoulder replacement surgery. LDRT sits in the middle ground between those two.

What the Evidence Covers

Be aware: most of the published sham-controlled trial evidence for LDRT, including the 2025 Korean randomized trial^[1] and the 2019 Dutch trial^[2], specifically studied knee osteoarthritis. The shoulder-specific evidence is thinner, but it exists and points in an encouraging direction: a 2024 treatment-planning case study in Medical Dosimetry walked through exactly how shoulder LDRT is planned and delivered^[3], and a German randomized trial of 312 patients with painful shoulder syndrome, a broader diagnosis that includes but is not limited to shoulder osteoarthritis, compared two doses: 83% responded right after treatment and 82% at long-term follow-up (median 35 months), with no significant difference between doses^[4].

UAB's radiation oncology team has described the evidence for LDRT in larger joints such as the shoulders and knees as robust^[5]. That said, shoulder evidence is still mostly observational rather than sham-controlled, so a radiation oncologist is the right person to explain how the available evidence applies to your shoulder in particular.

Typical Schedule

• Total dose of about 3.0 Gy, split into 6 treatments of 0.5 Gy each
• Treatments given 2 to 3 times per week, over about 2 to 3 weeks
• Outpatient, no hospital stay, no sedation or recovery period

Who May Be a Candidate

Programs generally consider adults with shoulder osteoarthritis who have not found enough relief from medications, injections, physical therapy, or other conservative treatments. As with other joints, many programs are cautious about younger patients, since radiation-related risk has more time to develop, and patients with more advanced structural damage may be less likely to improve. LDRT does not rebuild cartilage or restore a severely damaged joint.

Shoulder replacement surgery is a well-established option for advanced shoulder osteoarthritis when pain and disability remain severe despite non-surgical care. Where LDRT may fit is generally after conservative treatments have been tried and before or instead of surgery is being weighed, for patients who want to discuss a non-surgical option with a radiation oncologist.

References:
1. Kim BH, et al. Clinical Effectiveness of Single Course Low-Dose Radiation Therapy in Knee Osteoarthritis: Short-term Results from the Randomized, Sham-Controlled Trial. ASTRO 67th Annual Meeting Late-Breaking Abstract LBA 06. 2025. Abstract
2. Mahler EAM, et al. Effectiveness of low-dose radiation therapy on symptoms in patients with knee osteoarthritis: a randomised, double-blinded, sham-controlled trial. 2019. PubMed
3. An introduction to low dose radiation therapy for shoulder osteoarthritis. Medical Dosimetry. 2024. PubMed
4. Ott OJ, et al. The Erlangen Dose Optimization Trial for radiotherapy of benign painful shoulder syndrome. Long-term results. Strahlentherapie und Onkologie. 2014. Record
5. UAB St. Vincent's offers low-dose radiation for osteoarthritis. UAB News. UAB