From the Guidelines
Mild hypertrophic bony changes in the shoulder should be managed with conservative measures, including physical therapy and pain management, as the initial treatment approach, as recommended by recent guidelines 1.
Initial Assessment and Treatment
Mild hypertrophic bony changes in the shoulder refer to early degenerative changes where bone spurs (osteophytes) develop around the joint. These changes result from normal aging, repetitive use, or previous injury causing cartilage wear and bone remodeling. The treatment should begin with conservative measures including:
- Over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours as needed, not exceeding 4000mg daily) or NSAIDs such as ibuprofen (400-600mg three times daily with food) for 1-2 weeks during pain flares 1.
- Applying ice for 15-20 minutes several times daily when pain or inflammation occurs, and heat for stiffness.
- Physical therapy focusing on gentle range-of-motion exercises and strengthening of the rotator cuff muscles is recommended 2-3 times weekly for 6-8 weeks.
- Modifying activities to avoid overhead movements that aggravate symptoms.
Further Management
If symptoms persist beyond 4-6 weeks of conservative treatment, it is essential to consult with a healthcare provider about:
- Corticosteroid injections to reduce inflammation and relieve pain.
- Further imaging to assess progression of the condition, as imaging can play an important role in diagnosing postoperative complications of shoulder arthroplasties 1. It is crucial to note that the management of glenohumeral osteoarthritis remains controversial, and the scientific evidence on this topic can be significantly improved 1. However, recent studies suggest that total shoulder arthroplasty is recommended over hemiarthroplasty for advanced shoulder osteoarthrosis due to its superior clinical outcome 1.
From the Research
Shoulder Mild Hypertrophic Bony Changes
- Shoulder pain can be caused by various conditions, including rotator cuff disorders, acromioclavicular joint arthritis, and glenohumeral joint arthritis 2
- Mild hypertrophic bony changes can be a sign of osteoarthritis, which can cause joint pain and disability 3
- The diagnosis of shoulder pain is crucial in decision-making when treating a patient, and ultrasound is an important tool in the diagnostic and therapeutic pathway 4
- Treatment options for osteoarthritis-related pain include topical nonsteroidal anti-inflammatory drugs (NSAIDs), oral NSAIDs, and intraarticular injections with glucocorticoids 3
- In patients with mild osteoarthritis, topical NSAIDs can be recommended, while oral NSAIDs are suggested for patients with moderate to severe osteoarthritis 3
- Intra-articular injections of platelet-rich plasma may be effective in reducing pain and disability in patients with hip osteoarthritis, and may also be considered for shoulder osteoarthritis 5
Diagnostic Approach
- A thorough physical examination, including inspection, palpation, range of motion, strength, and neurovascular integrity, is essential in evaluating a patient with shoulder complaints 6
- Specific exam maneuvers can help isolate and differentiate pathologies, such as rotator cuff injury, shoulder instability, or impingement 6
- Correlating clinical assessment with imaging signs is important in diagnosing shoulder pain, and treating the patient rather than the images is crucial 4
Treatment Considerations
- The use of steroid injections in the presence of a rotator cuff tear should be carefully considered, and the sensible use of steroids and local anesthetics is important to avoid chondrotoxicity 4
- The efficacy of pharmacological therapies in osteoarthritis-related pain is often inconsistent, and severe adverse events may occur, highlighting the need for critical use of treatment options 3