From the Guidelines
Initial management for a patient with moderately severe glenohumeral joint space narrowing should focus on conservative measures before considering surgical intervention. The recommended approach begins with activity modification to avoid painful movements, combined with physical therapy focusing on rotator cuff strengthening and scapular stabilization exercises 2-3 times weekly for 6-8 weeks. Pain management should include acetaminophen (up to 3000mg daily in divided doses) or NSAIDs such as ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) 1. For patients with contraindications to NSAIDs, a corticosteroid injection into the glenohumeral joint (typically 40mg methylprednisolone or equivalent with 4-5ml of lidocaine 1%) can provide temporary relief for 1-3 months. Adjunctive treatments may include heat/cold therapy and activity pacing throughout the day.
Key Considerations
- The use of injectable viscosupplementation is considered a weak option for the treatment of glenohumeral osteoarthritis 1.
- Total shoulder arthroplasty is recommended over hemiarthroplasty, with a moderate-rated recommendation 1.
- Reverse shoulder arthroplasty for unrepairable tears with glenohumeral joint arthritis can improve patient-reported outcomes (PROs) after failure of conservative treatment 1.
Treatment Approach
- Conservative management should be the initial approach, addressing both pain and function while avoiding the risks of surgery.
- If symptoms persist after 3-6 months of consistent conservative management, surgical options like arthroscopic debridement or joint replacement may be considered depending on the patient's age, activity level, and degree of joint destruction.
- The treatment plan should be individualized, taking into account the patient's specific needs and circumstances.
From the Research
Initial Management for Moderately Severe Glenohumeral Joint Space Narrowing
The initial management for a patient with moderately severe glenohumeral joint space narrowing typically involves conservative treatment options.
- The goals of initial management are to decrease pain, increase shoulder range of motion (ROM), and protect the glenohumeral joint 2.
- Conservative treatment options include:
- Physical therapy to improve shoulder ROM and strengthen the rotator cuff muscles 2, 3, 4.
- Pharmacological therapy, such as non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation 2, 3, 4, 5.
- Biological therapy, such as platelet-rich plasma, bone marrow aspirate concentrate, and mesenchymal stem cells, although the evidence for these options is limited 2, 5.
- Intra-articular corticosteroid injections and hyaluronic acid injections may also be considered for patients with moderate to advanced arthritis or those who are not candidates for surgery 3, 4, 5.
- A comprehensive approach to glenohumeral arthritis should include a combination of non-operative and operative treatments, with the goal of improving pain and restoring function 6, 4.