The role of conservative treatment of glenohumeral joint osteoarthritis: a systematic review

Abstract

BackgroundGlenohumeral joint osteoarthritis is a highly prevalent musculoskeletal disease in adults over the age of 65. The first line of treatment typically consists of nonsurgical modalities prior to consideration for definitive treatment with total shoulder arthroplasty. Within this systematic review, we aim to assess the value of conservative management of glenohumeral osteoarthritis by evaluating the quality of available research and the efficacy of nonoperative treatment on patient-reported pain scores and functional outcome measures. MethodsA systematic review was conducted in literature published between 2000 and 2022. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the electronic databases, PubMed, EBSCO Host, Medline, and Google Scholar were searched. Studies included in analysis consisted of patients receiving nonoperative management of glenohumeral joint arthritis without concomitant additional shoulder pathologies with a measured intervention and reported patient outcome measure. Two blinded reviewers screened and evaluated the data quality using the Methodological Index for Nonrandomized Studies tool. ResultsNineteen studies were included consisting of 1879 patients with a median follow-up of 6 months. Eighteen studies included intra-articular injections including hyaluronic acid, corticosteroid, bone marrow aspirate, leukocyte-poor platelet-rich plasma, and autologous-conditioned serum injections. Each study reported symptomatic improvement following injection. Hyaluronic acid was the most commonly used (13 of 18 studies) agent with multiple studies demonstrating temporary improvement in pain and function. Four studies reported the outcomes of noninjectable modalities including physical therapy, bracing, and radiofrequency ablation. Two studies demonstrate that injections combined with physical therapy can lead to greater improvement in Constant score and range over motion for a greater period of time. ConclusionConservative treatment modalities can be effective in lowering pain scores and improving functional outcome scores in patients with glenohumeral osteoarthritis. The effect of each individual modality may be most effective when combined with other treatments. However, these benefits appear to be short-term. Additional studies are necessary to further determine the long-term efficacy and establish guidelines for the mainstay of first-line therapy in the management of glenohumeral joint osteoarthritis.