From the Guidelines
Advanced osteoarthritic changes at the glenohumeral joint should be managed with a comprehensive approach, prioritizing total shoulder arthroplasty for advanced cases with significant functional limitation, as it is the single moderate-rated recommendation for treatment 1.
Initial Management
Initial management includes:
- Acetaminophen (500-1000mg every 6 hours, not exceeding 4g daily) and NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (250-500mg twice daily) for pain relief.
- Physical therapy focusing on gentle range-of-motion exercises and strengthening of the rotator cuff and scapular stabilizers, typically 2-3 sessions weekly for 6-8 weeks.
- Activity modification to avoid overhead movements and heavy lifting is recommended.
Interventional Options
For patients with severe pain, intra-articular corticosteroid injections (such as methylprednisolone 40-80mg with lidocaine) can provide temporary relief, limited to 3-4 injections yearly 1. Viscosupplementation with hyaluronic acid may offer benefit for some patients.
Surgical Options
For patients with inadequate response to conservative measures after 3-6 months, surgical options include:
- Arthroscopic debridement for earlier disease.
- Total shoulder arthroplasty for advanced cases with significant functional limitation, which is the preferred surgical option 1. These interventions address the progressive cartilage loss, bone spur formation, and joint space narrowing characteristic of glenohumeral osteoarthritis, which typically causes pain, decreased range of motion, and functional limitations in the shoulder 1.
From the Research
Advanced Osteoarthritic Changes at the Glenohumeral Joint
- Advanced osteoarthritic changes at the glenohumeral joint are characterized by articular cartilage thinning, glenoid bone loss and deformity, osteophytosis, and other associated changes 2.
- The prevalence of glenohumeral osteoarthritis (GH-OA) is estimated to be between 85 and 94% in men and women over the age of 80 years 2.
- A diagnosis of GH-OA is established based on clinical history, physical examination, and radiographic assessments 2, 3.
Treatment Options
- Non-pharmacological treatment options may serve as adjuvants to other therapies and should be incorporated for a more holistic approach to management 2.
- Pharmacological treatments include oral agents such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, and antidepressants 2, 4.
- Intra-articular injections such as platelet-rich plasma, cortisone, and hyaluronic acid are usually used to control symptoms in moderate to advanced arthritis or in non-surgical candidates 2, 3.
- Surgical treatment of GH-OA is reserved for patients who do not respond to conservative management or who suffer from debilitating symptoms that severely impair their quality of life 2, 3.
Rehabilitation and Management
- Rehabilitation programs have proven to be efficient and reliable in the management of GH-OA 5.
- Evidence-based treatment recommendations are mostly supported by low-quality evidence and experts' opinions, with few high levels of evidence studies guiding treatment decisions 5.
- The aim of rehabilitation is to provide current information on the characteristics of the disease and the pathophysiology, evidence-based on medical and surgical treatments with emphasis on the rehabilitation process 5.