What is the recommended management for mild left acromioclavicular (AC) and glenohumeral joint arthritic changes without acute osseous abnormality?

Management of Mild Left AC and Glenohumeral Joint Arthritic Changes

First-line treatment for mild AC and glenohumeral joint arthritic changes should include exercise therapy, patient education, and NSAIDs, followed by more invasive options only if conservative management fails. 1

Initial Conservative Management

Exercise Therapy

• Focus on specific rotator cuff and periscapular muscle strengthening
• Include progressive range of motion exercises and scapular stabilization exercises 2
• Exercise therapy should progress through phases:
  • Phase 1: Pain control, gentle ROM exercises, proper positioning education
  • Phase 2: Progressive ROM exercises, light strengthening for rotator cuff and periscapular muscles
  • Phase 3: Progressive resistance training and advanced scapular stabilization 2

Pharmacologic Management

• NSAIDs are recommended as first-line medication for pain management
• Focus on tapering NSAIDs as tolerated to minimize side effects 2
• Acetaminophen can be used as an alternative if NSAIDs are contraindicated

Additional Conservative Measures

• Local cold therapy for pain relief 2
• Activity modification to reduce stress on affected joints 3
• Patient education about the condition and self-management strategies 1

Second-Line Interventions

Injectable Options

• Injectable viscosupplementation is an option when treating patients with glenohumeral OA (Grade C recommendation) 1

  • Hyaluronic acid injections may provide symptomatic relief for up to 6 months

• Corticosteroid injections:

  • Limited evidence for glenohumeral OA (no clear recommendation) 1
  • For AC joint OA, corticosteroid injections may provide short-term pain relief 3
  • Should be limited (typically no more than 3-4 per year) to avoid potential tendon weakening 2
  • Can be diagnostic as well as therapeutic 3

Surgical Options (for refractory cases)

• Consider only after a minimum of 6 months of unsuccessful conservative treatment 3
• For AC joint OA: Open or arthroscopic distal clavicle resection may be indicated 4, 3
• For glenohumeral OA:
  • Total shoulder arthroplasty (TSA) is preferred over hemiarthroplasty (Grade B recommendation) 1
  • Arthroscopic options have insufficient evidence to recommend for or against 1

Monitoring and Follow-up

• Initial follow-up: 1-2 weeks after treatment initiation to assess response
• Clinical reassessment at 6 weeks to evaluate progress
• Consider imaging or surgical consultation if symptoms worsen or do not improve by 3 months 2

Important Considerations

• The relationship between AC and glenohumeral joint involvement is important - both joints are frequently affected simultaneously in arthritic conditions 5
• AC joint pain may be overlooked when evaluating shoulder pain, but it's a common source that should be specifically assessed 3
• The natural progression of mild arthritic changes varies, but conservative management should be exhausted before considering invasive options
• Steroid injections may provide short-term relief but do not alter the natural progression of the disease 3

Pitfalls to Avoid

• Focusing only on the glenohumeral joint while neglecting the AC joint contribution to symptoms
• Overreliance on imaging findings without correlation to clinical symptoms
• Premature progression to surgical interventions before adequate trial of conservative management
• Excessive use of corticosteroid injections, which can lead to tendon weakening and other complications

Remember that normal X-ray findings do not rule out soft tissue pathology that may be contributing to symptoms, and treatment should address both the arthritic changes and any associated soft tissue dysfunction 2.