Osteoarthritis of the shoulder is a progressively degenerative disease that cannot be reversed. A variety of treatments are used to control the pain and slow the disease’s progression. Unfortunately, there is a lack of clinical research that establishes which nonsurgical shoulder osteoarthritis treatments work best for which patients. But this does not mean that treatments are not available or not effective. There is an array of effective treatments that can be used. Without definitive clinical guidelines to direct non-operative treatment, it’s very important that the patient and the doctor have a good relationship and speak quite frankly about the expectations and risks of treatment versus non-treatment. If a person responds very well to nonsurgical treatment, the degenerative process can be slowed down, the pain can be controlled, and surgery can sometimes be avoided all together, or at least postponed.
What are the nonsurgical shoulder osteoarthritis treatments?
- Activity modification: Common sense suggests if something hurts, you do not want to push through it. Shoulder osteoarthritis just means "wear and tear of the shoulder joints" such that some of the cartilage in that joint is damaged. By pushing through the pain, you could be causing additional damage. If we can decrease the pain, if we can control the pain, and don’t push through the pain through activity modification, often times we can lessen the extent of damage in that joint.
- Symptomatically, warm or cold compresses can be used. Both work in different ways: warmth will help to loosen up the shoulder joint, but it is not anti-inflammatory, whereas cold is anti-inflammatory and it can be more useful in decreasing the pain. But both can be used and alternated throughout the same day.
- Physical therapy is one of the main treatments, but aggressive physical therapy should be avoided because it can lead to further damage to the joint. But physical therapists know what is aggressive and what is not, and a good relationship between the physical therapist and the patient should help the physical therapist choose the best treatment. A physical therapist will typically work on increasing the shoulder’s range of motion, stabilizing the shoulder, increasing shoulder strength, and developing coping techniques to do certain painful activities in a different way.
- Medications can be useful, but it is important to discuss with your physician the side effects and interactions with other medications. There is an array of medications, for example, analgesics such as over-the-counter medicines like acetaminophen (Tylenol) do not have an anti-inflammatory effect; rather it decreases one’s perception of pain. There are also non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil), naproxen (Aleve), as well as prescription strength selective COX-2 inhibitors such as Celebrex and Mobic which have less of a bleeding effect and can be used by certain people. There are also topical medications that are generally NSAIDs, such as diclofenac, that can be placed over the shoulder itself in the form of a gel or patch. It is important to note that since topical medications will only treat the area where the gel or patch is placed, there is less systemic uptake and therefore less side effect. Topical analgesics such as counter-irritants including wintergreen and eucalyptus stimulate the nerve endings in the shoulder to distract the brain from the pain. There are some over-the-counter options for topical analgesics such as Bengay, Icy-Hot, and Zostrix.
- Glucosamine and Chondroitin sometimes can help with joint pain, although studies are mixed. Some have shown favorable results while others have not. Glucosamine and chondroitin are certainly options and something that can be discussed with your physician.
- Injections into the shoulder can also be useful; these include steroid injections, prolotherapy type injections, and viscosupplementation. The steroid will decrease inflammation, prolotherapy or PRP therapy will help with regeneration, while viscosupplementation injects a lubricating agent made from rooster comb to decrease friction in the joint.
- Finally, there are coping techniques such as relaxation, meditation, visual imagery, biofeedback, and even hypnosis.