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Shoulder osteoarthritis

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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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Guidelines

1.Diagnostic investigations

History and physical examination: elicit history and perform a physical examination for differential diagnosis of glenohumeral OA.
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  • Diagnostic imaging

2.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

3.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

4.Therapeutic procedures

Hyaluronic acid injections: 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

5.Perioperative care

Management of intraoperative blood loss: consider administering tranexamic acid during shoulder arthroplasty for reducing blood loss and risk of blood transfusion.
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6.Surgical interventions

Total shoulder arthroplasty, indications, AAOS: 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