One study showed that acetaminophen was more effective than placebo in pain reduction but less effective than NSAIDS. Phar- macological results have shown that newer COX-2 selective in- hibitors are not more effective than NSAIDS are for treating knee and hip OA. Another study showed that COX-2 inhibitors caused fewer gastrointestinal problems than NSAIDS did. More studies need to be done on this topic to look at the effectiveness of these drugs on shoulder OA and the serious cardiovascular side effects. Nutritional supplements are widely used for OA treatment but are not approved by the Food and Drug Administration (FDA). Glu- cosamine has been shown to provide moderate symptom relief over placebo, but the overall effectiveness in the treatment of OA is uncertain. There is not enough evidence at this point to sup- port the use of these supplements in the treatment of shoulder degenerative disease.
and selective COX-2 inhibitors—have been effective in alleviating symptoms of osteoarthritis—but they can also have side effects. The definition of failure of conservative treatment of shoulder OA varies from surgeon to surgeon. Nonsurgical management for the treatment of shoulder OA information is limited in the literature. Comprehensive conservative management of shoulder OA can produce satisfactory midterm outcomes in unilateral shoulder OA patients according to one study. Nonsurgical management of shoulder OA can temporarily relieve symptoms; however, it will not alter the natural history of shoulder OA or shoulder joint degeneration and can have unsatisfactory re- sults. Nonpharmacologic measures, such as aerobic exercise and strengthening, are not proven successful for shoulder OA.
Study Report One study looked at 129 patients older than 65 years under a conservative management approach to shoulder OA. This study fol - lowed these patients over the course of three years. Treatments included conventional therapy: nonsteroidal anti-inflammatory medi - cation, corticosteroid injections, sodium hyaluronate, and education at the discretion of the physician. Some patients also received physiotherapy, rehabilitation training, a shoulder strap to improve the range of motion, and muscular strength training from a physical therapist. The parameters of testing procedures included comparing the effectiveness of each therapeutic method, visual analog scaled (VAS), Simple Shoulder Test (SST), and Short Form (36) Health Survey (SF-36) scores. At a three-year follow-up, most patients had a significant increase from their pretreatment values in pain, self-assessed shoulder function, mental health, and with five of the eight SF-36 domains. The study showed a decline in SST and VAS at 6 and 12 months after the initial three-month period and demonstrated that combined therapy could improve symptoms significantly based on the results of this study. A conservative approach may be more appropriate and can produce satisfactory outcomes in select cases. The findings of this study suggest that conservative treatments should be ex - tended for longer than 12 months before the decision regarding shoulder arthroplasty is made. Surgical treatment
arthropathy, osteonecrosis, and a previously failed joint-sparing surgery or total shoulder arthroplasty. Total shoulder arthroplasty, which involves replacing the glenoid and humerus, is supported by recent studies. Contraindications for a total shoulder replacement are active or recent infection, neuropathic joint, complete paralysis of deltoid or rotator cuff muscles, debilitating medical status, and uncorrectable shoulder instability. Overview of surgery: TSA and reverse TSA Surgical management may be needed if conservative measures fail. Shoulder arthroscopy, as stated previously, is needed for pa - tients with severe osteoarthritis but also for other shoulder condi- tions that limit function and lead to pain. In certain instances, a hemiarthroscopy may be recommended, which involves replacing only the humerus. Shoulder arthroscopy is generally performed under general anesthesia with a regional nerve anesthetic com- monly used to supplement general anesthesia and provide peri- operative pain control. After careful surgical exposure, the glenoid fossa is resurfaced with a solid polyethylene component; the humeral head is then resected along the anatomic neck and replaced with a metal pros- thesis. Reverse, or inverse, shoulder replacements have been de- signed specifically for the use of rotator cuff-deficient shoulders. The procedure usually lasts from one to three hours, followed by a two-to-four-day postoperative hospitalization. Generally, blood loss is minimal; patients should not need blood transfusions fol- lowing these types of procedures. Pain is controlled while in the hospital using intravenous patient-controlled analgesia. A sling should be used following the procedure for three to six weeks to protect the repair, depending on the surgeon’s postoperative protocol and instructions. When joint mechanics are altered in a rotator cuff-deficient shoul- der, the use of a conventional TSA prosthesis often results in sub- optimal outcomes. Normal glenohumeral joint mechanics are not restored following TSA when in the presence of a deficient rotator cuff.
Surgical management may be needed if conservative measures fail. Joint preservation surgery is preferable for patients younger than 55 to 60 years or those with early stage degenerative joint disease of the shoulder. The operative procedure should match the symptoms and functional limitations of the patient. Surgi- cal options include arthroscopic debridement, capsular release, corrective osteotomies, and interposition arthroplasty, which can help to reduce symptoms while preserving the native joint. The most common surgical treatment is arthroscopic debride- ment with capsular release, which is the most effective in patients younger than 55 to 60 years with moderate pain and significant passive motion restrictions. Debridement removes mechanical ir- ritants, unstable cartilage flaps, or loose bodies. Inflamed syno- vial can be treated with a synovectomy, and the stiff contracted joint capsule can be released to restore passive joint mobility and unload articular surfaces. A shoulder fusion, or arthrodesis, is an option for patients younger than 45 to 50 years old who have se- vere arthritis, or for those who are not suitable candidates for total replacement. The shoulder fusion helps to eliminate pain by fus- ing the humeral head to the glenoid, which eliminates the painful motion interface. Few studies exist on joint-preservation surgery for the shoulder. Several case reports and small series studies have presented carti - lage-resurfacing procedures for young patients with focal chondral defects. The largest series on arthroscopic management consisted of 25 patients with early to moderate OA who were treated with lavage partial synovectomy and subacromial decompression with a follow-up after 34 months. The follow-up demonstrated good or excellent outcomes in 80% of the patients. The authors concluded that arthroscopic debridement is reasonable for early shoulder OA treatment. Surgical prerequisites for this type of procedure in this study were concentric humeral head and glenoid with visible joint space on an axillary radiograph. Shoulder arthroscopy is recommended for patients with severe shoulder OA. The most common indications for a total shoulder replacement are pain and shoulder arthritis with a loss of function unresponsive to conservative treatment, end-stage rotator cuff tear
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