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Shoulder osteoarthritis

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Updated 2023 APTA guidelines for physical therapy in shoulder osteoarthritis.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of shoulder osteoarthritis are prepared by our editorial team based on guidelines from the American Physical Therapy Association (APTA 2023), the American Academy of Orthopaedic Surgeons (AAOS 2020), and the American Academy of Family Physicians (AAFP 2008)....
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Diagnostic investigations

History and physical examination: as per APTA 2023 guidelines, Elicit history and perform a physical examination for differential diagnosis of glenohumeral OA.
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  • Diagnostic imaging

Medical management

Pain management: as per AAOS 2020 guidelines, Consider avoiding routine and long-term opioids for pain management in patients with glenohumeral OA.
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  • Glucosamine and chondroitin

Nonpharmacologic interventions

Physical therapy: as per APTA 2023 guidelines, Offer a sling and progressive exercises for ROM and strengthening after total shoulder arthroplasty to improve patient-reported outcomes and ROM in patients with glenohumeral OA.
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  • Alternative and complementary therapies

Therapeutic procedures

Hyaluronic acid injections: as per AAOS 2020 guidelines, Do not use hyaluronic acid for the treatment of patients with glenohumeral joint OA.
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  • Biologic injections

  • Cryotherapy

  • Transcutaneous electrical nerve stimulation

Perioperative care

Perioperative tranexamic acid: as per AAOS 2020 guidelines, Consider administering tranexamic acid to reduce blood loss and risk of blood transfusion in shoulder arthroplasty.
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Surgical interventions

Total shoulder arthroplasty, indications: as per AAOS 2020 guidelines, Perform anatomic total shoulder arthroplasty rather than hemiarthroplasty for the treatment of patients with glenohumeral OA, as it demonstrates more favorable function and pain relief in the short- to mid-term follow-up.
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  • Total shoulder arthroplasty (technical considerations)

  • Total shoulder arthroplasty (shoulder prosthesis)

  • Total shoulder arthroplasty (outcomes and discharge)

  • Non-prosthetic surgical interventions