From the Guidelines
Osteoarthritic hypertrophic bony changes at the glenohumeral and acromioclavicular joints should be managed with a multimodal approach, prioritizing conservative measures and reserving surgical options for severe cases unresponsive to initial treatment, as recommended by the most recent guidelines 1. The management of osteoarthritic hypertrophic bony changes at the glenohumeral and acromioclavicular joints involves a comprehensive approach to alleviate pain, improve mobility, and enhance quality of life.
Conservative Management
Conservative measures include:
- NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain and inflammation
- Physical therapy focusing on range-of-motion exercises and strengthening of the rotator cuff muscles, typically 2-3 sessions weekly for 6-8 weeks
- Corticosteroid injections (such as methylprednisolone 40mg mixed with lidocaine) for temporary relief in severe cases
- Activity modification to avoid overhead movements and heavy lifting
- Heat and cold therapy to manage pain at home These measures are supported by evidence from studies on the treatment of glenohumeral osteoarthritis 1.
Surgical Options
For severe cases unresponsive to conservative treatment, surgical options may be considered, including:
- Arthroscopic debridement
- Partial or total joint replacement The choice of surgical procedure depends on the extent of the degenerative changes and the patient's overall health status, as discussed in the context of shoulder arthroplasties 1.
Imaging and Diagnosis
Imaging plays a crucial role in diagnosing postoperative complications of shoulder arthroplasties, and the imaging algorithm should always begin with an assessment of the hardware components, alignment, and surrounding osseous and soft-tissue structures 1.
Key Considerations
The complication rate for shoulder arthroplasties can be high, with revision rates up to 11% 1, highlighting the importance of careful patient selection and thorough preoperative evaluation. By prioritizing conservative measures and reserving surgical options for severe cases, clinicians can optimize outcomes and improve quality of life for patients with osteoarthritic hypertrophic bony changes at the glenohumeral and acromioclavicular joints.
From the Research
Osteoarthritic Hypertrophic Bony Changes
- Osteoarthritis (OA) can affect the glenohumeral and acromioclavicular joints, leading to hypertrophic bony changes and resulting in pain and functional disability of the shoulder 2, 3, 4, 5, 6.
Glenohumeral Joint Osteoarthritis
- The glenohumeral joint is the third most common large joint affected by OA, with 16% to 20% of adults older than 65 years showing radiographic signs of glenohumeral joint OA 2.
- Management of shoulder OA starts with conservative therapies, including oral drugs, injections, and physical therapy, with joint replacement considered if conservative measures are not effective 2, 3, 4, 5.
Acromioclavicular Joint Osteoarthritis
- Osteoarthritis of the acromioclavicular joint is a common source of shoulder pain that is often neglected by clinicians and researchers 6.
- Diagnosis of acromioclavicular joint osteoarthritis requires a thorough physical exam, plain-film radiograph, and a diagnostic local anesthetic injection, with treatment options including oral analgesics or anti-inflammatories, activity modification, and corticosteroid injections 6.
- Surgical options, such as open or arthroscopic distal clavicle resection, may be considered after a minimum of 6 months of unsuccessful conservative treatment 6.