What are the guideline sources, guidelines and references for Shoulder osteoarthritis ?
Guideline 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 Academy of Orthopaedic Surgeons (AAOS 2020) and the American Association of Family Physicians (AAFP 2008). 1 2 Guidelines 1. Diagnostic investigations Shoulder radiography: As per AAOS 2020 guidelines, consider obtaining axillary and true anteroposterior (Grashey view) radiographs, with advanced imaging performed at the discretion of the clinician, in patients with glenohumeral OA undergoing arthroplasty. E https://web.pathway.md/diseases/recsfozCGQUK9Wpvn 1/4 6/24/23, 3:06 PM Shoulder osteoarthritis Pathway As per AAFP 2008 guidelines: Obtain axillary radiography because it provides the best images of joint-space narrowing to diagnose degenerative joint disease of the shoulder and to help ruling out dislocation. B Obtain anteroposterior radiography with the arm actively held at 45 degrees of abduction to reveal joint-space narrowing in patients with otherwise normal neutral anteroposterior radiography. B 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. D Consider offering multimodal pain management strategies or non-opioid individual modalities for postoperative pain management following shoulder arthroplasty. E As per AAFP 2008 guidelines: Consider prescribing OTC medications for pain relief in certain patients with early glenohumeral OA. C Prescribe acetaminophen as first-line pharmacologic agent for pain management in patients with glenohumeral OA. Recognize that therapeutic effects are achieved at dosages of 3-4 g/day. B Glucosamine and chondroitin: insufficient evidence to recommend for or against the use of glucosamine or chondroitin in patients with glenohumeral joint OA. I 3. Nonpharmacologic interventions Physical therapy: As per AAOS 2020 guidelines: Consider offering physical therapy in selected patients with glenohumeral joint OA. E Consider offering physical therapy in patients following shoulder arthroplasty. E As per AAFP 2008 guidelines: Advise activity modification, rest, and ice as the initial approach in patients with early glenohumeral OA. B Offer physical therapy, strength training, and aerobic exercise to alleviate symptoms in certain patients with early glenohumeral OA. B Acupuncture and cupping: insufficient evidence to recommend for or against the use of acupuncture, dry needling or cupping in patients with glenohumeral joint OA. I Cannabis: insufficient evidence to recommend for or against the use of cannabis or cannabodiol oil in patients with glenohumeral joint OA. I https://web.pathway.md/diseases/recsfozCGQUK9Wpvn 2/4 6/24/23, 3:06 PM Shoulder osteoarthritis Pathway Capsaicin: insufficient evidence to recommend for or against the use of capsaicin in patients with glenohumeral joint OA. I Shark cartilage: insufficient evidence to recommend for or against the use of shark cartilage in patients with glenohumeral joint OA. I 4. Therapeutic procedures Hyaluronic acid injections: do not use hyaluronic acid for the treatment of patients with glenohumeral joint OA. D Biologic injections: consider avoiding injectable biologics, such as stem cells or platelet-rich plasma, for the treatment of patients with glenohumeral OA. D Cryotherapy: consider using either continuous cryotherapy or cold packs following shoulder arthroplasty. E Transcutaneous electrical nerve stimulation: insufficient evidence to recommend for or against the use of transcutaneous electrical nerve stimulation in patients with glenohumeral joint OA. I 5. Perioperative care Management of intraoperative blood loss: consider administering tranexamic acid during shoulder arthroplasty for reducing blood loss and risk of blood transfusion. E 6. 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. A As per AAFP 2008 guidelines, recognize that the most common indications for shoulder arthroplasty are: pain from shoulder arthritis with a loss of function that is unresponsive to conservative treatment end-stage rotator cuff tear arthropathy osteonecrosis a previously failed joint-sparing surgery or total shoulder arthroplasty. B Total shoulder arthroplasty (technical considerations): consider performing either anatomic or reverse total shoulder arthroplasty for the treatment of selected patients with glenohumeral joint OA and excessive glenoid bone loss and/or rotator cuff dysfunction. E Show 3 more https://web.pathway.md/diseases/recsfozCGQUK9Wpvn 3/4 6/24/23, 3:06 PM Shoulder osteoarthritis Pathway Total shoulder arthroplasty (shoulder prosthesis): use pegged or keeled glenoid components in patients with glenohumeral joint OA and a well-functioning rotator cuff. Recognize that pegged components demonstrate less radiolucent lines, but the effect on clinical outcomes and survivorship are unclear. A Show 4 more Total shoulder arthroplasty (outcomes and discharge): Recognize that: older age at the time of surgery is associated with lower revision rates B gender is not associated with better or worse postoperative outcomes A obesity is not associated with higher rates of early postoperative complications A smoking is associated with inferior postoperative outcomes B depression is associated with inferior postoperative outcomes B more comorbidities are associated with higher rates of early postoperative complications A while both higher and lower preoperative functioning patients will likely experience improvement following arthroplasty, patients with higher preoperative function may experience less functional improvement. B Consider discharging selected patients after shoulder arthroplasty on the same day. E Non-prosthetic surgical interventions: consider performing non-prosthetic surgical options for the treatment of patients with glenohumeral joint OA, which may or may not provide short-term benefit. E References 1. Michael Khazzam, Albert O Gee, Michael Pearl. Management of Glenohumeral Joint Osteoarthritis. J Am Acad Orthop Surg. 2020 Oct 1;28 19 781 789. Open 2. Peter J Millett, Reuben Gobezie, Robert E Boykin. Shoulder osteoarthritis: diagnosis and management. Am Fam Physician. 2008 Sep 1;78 5 605 11. Open https://web.pathway.md/diseases/recsfozCGQUK9Wpvn 4/4