First-Line Treatment for Glenohumeral Arthritis
Start with physical therapy combined with oral NSAIDs as first-line treatment for glenohumeral arthritis in older adults without significant comorbidities. 1, 2
Initial Conservative Management Algorithm
Non-Pharmacologic Interventions (Start Immediately)
Physical therapy is the cornerstone of initial treatment, targeting three specific goals: (1) decrease pain, (2) increase shoulder range of motion, and (3) protect the glenohumeral joint through rotator cuff strengthening exercises 2
Physical therapy is most effective for motion-related pain rather than rest pain, so assess pain patterns before initiating therapy 2
Address abnormal scapular motion patterns that develop as compensation for restricted glenohumeral motion 2
Identify specific soft tissues responsible for ROM loss and target them for intervention 2
Pharmacologic Interventions (Initiate Concurrently)
Oral NSAIDs are recommended as first-line pharmacologic therapy for glenohumeral osteoarthritis, providing both pain reduction and diminution of joint inflammation 2
Use the lowest effective dose for the shortest possible duration to minimize gastrointestinal, renal, and cardiovascular risks 2
Consider supplementation with oral vitamin C and vitamin D to help slow cartilage degeneration 2
The pharmacologic approach interrupts the chronic inflammatory state in the joint, enabling more effective pain-free physical therapy 2
Second-Line Options When Initial Treatment Fails
Injectable Therapies
Intra-articular corticosteroid injections have insufficient evidence to recommend for or against their use (Grade I recommendation from the American Academy of Orthopaedic Surgeons) 1
Viscosupplementation (hyaluronic acid injections) is a treatment option with weak supporting evidence (Grade C recommendation) 1
Biologics such as platelet-rich plasma, bone marrow aspirate concentrate, and mesenchymal stem cells may decrease shoulder pain but neither stop progression nor improve osteoarthritis, with limited evidence for their effectiveness 2
Critical Considerations and Pitfalls
Treatment Selection Factors
The American Academy of Orthopaedic Surgeons recommends treatment be dictated by patient age, severity of symptoms, radiographic findings, and medical comorbidities 1
Most pharmacotherapy recommendations are extrapolated from hip and knee osteoarthritis literature, with limited specific evidence for glenohumeral OA 1
Physical therapy lacks high-quality evidence supporting its efficacy specifically for glenohumeral arthritis, though it remains a standard recommendation 1
Common Pitfalls to Avoid
Never prescribe oral NSAIDs without assessing cardiovascular, gastrointestinal, and renal risk factors, particularly in patients over 50 years 3
Avoid prolonged NSAID use at high doses in elderly patients who face substantially higher risks of GI bleeding, renal insufficiency, and cardiovascular complications 3
Do not rely solely on pharmacological treatment—optimal management requires combining non-pharmacological and pharmacological modalities 4
When to Consider Surgical Referral
Surgical treatment is indicated in severe or refractory cases when nonoperative management has failed 5
Total shoulder arthroplasty is the preferred surgical option for advanced glenohumeral osteoarthritis, providing superior clinical outcomes compared to hemiarthroplasty (moderate-strength evidence, Grade B recommendation) 1
Avoid arthroplasty in patients <50 years when possible due to increased risk of prosthetic loosening and decreased survivorship 1