Treatment of Glenohumeral Joint Narrowing
For glenohumeral joint narrowing (osteoarthritis), begin with conservative management including physical therapy and pharmacotherapy, but proceed to total shoulder arthroplasty when conservative measures fail, as TSA provides superior outcomes compared to hemiarthroplasty for advanced disease. 1
Initial Conservative Management
Treatment should be guided by patient age, symptom severity, radiographic findings, and medical comorbidities 1. The conservative approach includes:
Physical therapy is a reasonable first-line option, though high-quality evidence supporting its efficacy is lacking 1. Case reports suggest manual physical therapy combined with exercises can provide clinically meaningful improvements in pain and function, even in younger active patients 2.
Pharmacotherapy should be considered, though recommendations are extrapolated from hip and knee osteoarthritis literature rather than shoulder-specific studies 1.
Injectable corticosteroids have insufficient evidence to recommend for or against their use (Grade I recommendation) 1.
Viscosupplementation is a treatment option with weak recommendation 1.
Important caveat: Most conservative treatment recommendations lack shoulder-specific evidence and are extrapolated from other joints 1. Despite this limitation, conservative therapy should be attempted before surgical intervention in appropriate candidates.
Pre-Surgical Evaluation
Before considering arthroplasty, obtain comprehensive imaging to evaluate:
- Glenoid morphology, including central and posterior bone loss 1, 3
- Glenoid retroversion and biconcavity 1, 3
- Inclination, osteophyte formation, and bone quality 1, 3
- Rotator cuff integrity - this is critical for surgical planning 1
Surgical Intervention
When Conservative Management Fails:
Total shoulder arthroplasty (TSA) is superior to hemiarthroplasty for advanced glenohumeral osteoarthritis, with moderate-strength evidence supporting this recommendation 1.
Critical Decision Point - Rotator Cuff Status:
If rotator cuff is intact: Proceed with TSA 1
If irreparable rotator cuff tear is present: TSA should NOT be performed according to American Academy of Orthopaedic Surgeons consensus 4, 1. Instead, consider reverse total shoulder arthroplasty as an alternative 1.
Perioperative Management:
- Use mechanical and/or chemical venous thromboembolism prophylaxis for all shoulder arthroplasty patients (consensus recommendation) 1.
Prosthetic Considerations:
All-polyethylene glenoid components have lower revision rates (1.7%) compared to metal-backed glenoids (6.8%) 4.
No specific humeral prosthetic design or fixation method can be recommended over another due to insufficient evidence 4.
Biceps tendon management (tenotomy vs tenodesis) lacks evidence for specific recommendations 4.
Postoperative Rehabilitation
Physical therapy following shoulder arthroplasty is commonly practiced, but no high-quality studies demonstrate whether it improves outcomes (Grade I recommendation) 4, 1.
Despite the lack of evidence, formal rehabilitation programs are standard practice and considered reliable 5.
Critical Pitfalls to Avoid
Complications occur in up to 39.8% of shoulder arthroplasty cases, with revision rates up to 11% 1.
Procedure-specific complications include:
Do not perform TSA in patients with irreparable rotator cuff tears - this is a consensus recommendation that should be strictly followed 4, 1.
Most treatment recommendations are based on low-quality evidence and expert opinion rather than high-quality shoulder-specific studies 1, 5.