Surgical treatment of patients with rheumatoid arthritis of the shoulder should be one part of a concept of conservative and surgical treatment. In addition to disease-modifying agents, local minimally invasive surgery can avoid structural damage to the shoulder and furthermore achieve a restitution of shoulder function. According to Larsen Stage 0-III, an arthroscopic synovectomy and bursectomy can achieve a good prognosis and help to avoid further structural damage to the rheumatoid shoulder. Minimally invasive procedures in the surgery of the rheumatoid shoulder lead to less immobilisation and faster rehabilitation, to the benefit of the joints in the operated limb, much like therapy of the knee. It is also possible to treat associated pathologies with minimally invasive surgery, such as bursitis, small rotator cuff defects, and synovitis of the acromioclavicular joint, as well as synovectomy of the glenohumeral joint Good results can be achieved in these cases using minimally invasive surgery. However, minimally invasive reconstructive procedures are limited in the rheumatoid shoulder.