What are the non-surgical options for managing osteophytes on the humeral head causing pain and limited range of motion (ROM)?

Non-Surgical Management of Osteophytes on the Humeral Head

Physical therapy combined with pharmacological management is the recommended first-line approach for managing osteophytes on the humeral head causing pain and limited range of motion. 1

Core Treatment Strategies

Physical Therapy and Exercise

• Physical therapy should be offered as part of a comprehensive management plan for patients with osteophytes causing shoulder pain and limited ROM 1
• Targeted exercises focusing on strengthening and improving range of motion can help maintain function and reduce pain 1
• Regular self-directed exercise programs can be beneficial when properly instructed by a physical therapist 1

Pharmacological Management

Topical Treatments

• Topical NSAIDs should be considered as first-line pharmacological treatment due to their effectiveness and lower risk of systemic side effects 1
• Topical capsaicin may be offered as an alternative topical agent for pain management 1

Oral Medications

• Acetaminophen and/or oral NSAIDs are recommended for pain management in patients with osteoarthritis causing pain 1
• Oral NSAIDs are frequently used and generally well-tolerated for managing osteoarthritis pain 1
• Duloxetine can be considered as an alternative or adjunctive therapy for patients with inadequate response to acetaminophen or NSAIDs 1
• Opioids (including tramadol) should be avoided as initial therapy for pain management 1

Intra-articular Injections

• Intra-articular corticosteroid injections may be offered for persistent pain inadequately relieved by other interventions 1
• Evidence regarding viscosupplementation (hyaluronic acid injections) specifically for shoulder osteoarthritis with osteophytes is limited 1

Special Considerations

Mechanical Impingement

• Osteophytes on the humeral head can cause mechanical impingement and potentially affect the axillary nerve, leading to teres minor muscle changes 2
• Inferior humeral osteophytes may be associated with axillary nerve entrapment, which can contribute to pain and dysfunction 2
• Superior humeral osteophytes are associated with rotator cuff insufficiency, including decreased supraspinatus tendon thickness and fatty infiltration 3

Advanced Pharmacological Options

• Bisphosphonates may be considered in the medical management of osteophytes, though evidence is limited 4
• Early-stage osteonecrosis (which can be associated with osteophytes) may benefit from treatments such as statins, bisphosphonates, or anticoagulants, though supporting data is limited 1

When to Consider Surgical Options

• Surgical intervention should be considered when non-surgical management fails to provide adequate pain relief and functional improvement 1
• For younger patients (<50 years), there should be caution regarding shoulder arthroplasty due to potential risks of prosthetic loosening and decreased survivorship 1
• Arthroscopic options may be considered for early stages of osteoarthritis with osteophytes, though evidence is inconclusive 1
• In cases of severe osteoarthritis with osteophytes, total shoulder arthroplasty (TSA) is suggested over hemiarthroplasty based on better outcomes for pain relief and lower revision rates 1

Monitoring and Follow-up

• Regular reassessment of pain and functional limitations is essential to determine treatment effectiveness 1
• If initial management approaches fail to improve pain or function, consider combination therapy or referral for additional physical therapy 1
• Weight-bearing radiographs should be obtained before surgical consultation if non-surgical management fails 1