From the Guidelines
For a 62-year-old male with glenohumeral and acromioclavicular osteoarthritis who failed to respond to steroid injection, I strongly recommend considering total shoulder arthroplasty as a treatment option, given the patient's age and the severity of symptoms, as evidenced by the narrowed glenohumeral joint spacing and prominent osteophyte formation 1.
Given the patient's history of steroid injection three months prior that did not provide relief, and considering the radiographic findings of osteoarthritic hypertrophic bony changes at the glenohumeral and acromioclavicular joints, a more invasive approach may be necessary to improve the patient's quality of life and reduce morbidity.
The patient's symptoms and radiographic findings suggest advanced osteoarthritis, which may not respond adequately to conservative management alone. While non-pharmacological interventions such as physical therapy focusing on shoulder-specific exercises and pharmacological interventions like oral NSAIDs (e.g., naproxen 500mg twice daily or celecoxib 200mg daily) and topical NSAIDs (e.g., diclofenac gel 1% applied four times daily) can be beneficial, the patient's failure to respond to previous steroid injection indicates a need for a more definitive treatment approach.
Key considerations in the management of this patient include:
- The patient's age and overall health status, which may influence the decision for surgery
- The severity of symptoms and impact on quality of life, which suggests a need for a more effective treatment strategy
- The radiographic findings, which indicate advanced osteoarthritis with significant joint space narrowing and osteophyte formation
In light of these considerations and based on the clinical practice guideline for the treatment of glenohumeral osteoarthritis 1, total shoulder arthroplasty emerges as a viable option for this patient, given its potential to significantly improve functional outcomes and reduce pain, thereby enhancing the patient's quality of life.
From the Research
Treatment Options for Osteoarthritis
The patient's condition, osteoarthritis of the glenohumeral and acromioclavicular joints, requires a comprehensive treatment approach. Considering the patient's lack of response to steroid injection three months ago, alternative treatment options should be explored.
- Multimodal Approach: A multimodal approach to osteoarthritis treatment is recommended, combining pharmacologic and nonpharmacologic therapies to improve efficacy and reduce the risk of adverse events 2.
- Nonpharmacologic Therapies: Joint-preserving interventions, such as joint-protection techniques, manual therapy, adaptive equipment provision, and exercise programs, can be beneficial in managing osteoarthritis symptoms 3.
- Pharmacologic Therapies: Oral nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain relief, but their use should be carefully considered due to potential gastrointestinal and cardiovascular risks 2, 4.
- Intra-Articular Injections: Intra-articular injections of platelet-rich plasma (PRP) or hyaluronic acid (HA) may be considered for patients who have not responded to conventional treatment 5, 6. PRP injection has shown promising results in reducing symptoms and improving quality of life in patients with knee osteoarthritis 6.
Considerations for Treatment
When selecting a treatment approach, it is essential to consider the patient's individual needs, medical history, and potential risks associated with each therapy.
- Pain Severity: Treatment modalities may differ based on pain severity, with more patients with moderate or severe pain receiving prescription medications 4.
- Combination Therapy: Combining nonpharmacologic and pharmacologic treatments is common, but higher pain ratings are associated with multiple failed prescription treatments 4.
- Alternative Therapies: Alternative therapies, such as PRP or HA injections, may be considered for patients who have not responded to conventional treatment or have contraindications to traditional therapies 5, 6.