by Amanda Francois, DPT, PT, ATC
As a physical therapist, I frequently work with patients experiencing shoulder osteoarthritis (OA), particularly glenohumeral OA. I have seen firsthand how this condition affects both older adults and athletes, causing pain, stiffness, and limited mobility. My goal is always to help patients manage their symptoms effectively, improve function, and delay or even prevent the need for surgery. In this article, I will share my insights on non-surgical approaches, including shoulder physical therapy, pharmacological treatments, and biologic therapies, that can help individuals with glenohumeral OA maintain an active lifestyle.
Understanding Glenohumeral Osteoarthritis
From my experience treating patients, I have found that glenohumeral OA is one of the most common causes of persistent shoulder pain. Many of my older patients come in complaining of stiffness and discomfort, and X-rays often confirm signs of joint degeneration. Research suggests that between 16% and 20% of individuals over 65 have radiographic evidence of this condition. Limited range of motion (ROM) is a frequent complaint, and in many cases, patients develop compensatory movement patterns that further strain surrounding muscles and tissues. Addressing these movement dysfunctions early is key to preventing further disability.
The Role of Physical Therapy in Managing Shoulder OA
In my practice, physical therapy remains one of the most effective non-surgical treatment options for shoulder OA. The main objectives of therapy include reducing pain, improving ROM, and strengthening the surrounding musculature to stabilize the joint.
Reducing Pain
Patients often report varying degrees of pain, and I tailor treatment based on whether discomfort occurs at rest or during movement. Movement-related pain responds well to therapeutic exercises, while persistent pain at rest may require additional interventions such as heat therapy or manual therapy techniques.
Increasing Shoulder ROM
I’ve seen many patients struggle with limited ROM due to joint stiffness, soft tissue tightness, or pain. A structured stretching program targeting key muscles—such as the pectoralis major, latissimus dorsi, and deltoid—can significantly improve shoulder mobility. I often incorporate gentle joint mobilizations and passive stretching to help patients regain functional movement.
Protecting the Joint
Strengthening exercises, especially for the rotator cuff muscles, play a crucial role in joint stabilization. I guide my patients through progressive resistance exercises targeting the supraspinatus, infraspinatus, and subscapularis to enhance shoulder support and reduce stress on the joint. Isometric exercises are also beneficial for those experiencing significant pain.
Pharmacological Treatments for Shoulder OA
While I focus on movement-based therapy, I often work in collaboration with physicians who prescribe medications to help manage pain and inflammation.
- NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Many of my patients find relief with NSAIDs, which reduce inflammation and provide significant pain relief. Topical NSAIDs are a suitable alternative for those who cannot tolerate oral medications.
- Corticosteroid Injections: Some patients benefit from intra-articular corticosteroid injections, particularly those with acute flare-ups. However, I always caution against frequent injections, as they may accelerate cartilage breakdown.
- Supplements: I sometimes recommend vitamin C and vitamin D supplementation to support joint health. While research on their effectiveness varies, some patients report mild improvements in symptoms.
Biologic Therapies: PRP and Stem Cells
Over the years, I have seen an increasing number of patients inquire about biologic therapies such as platelet-rich plasma (PRP) and stem cell treatments. While these therapies show promise in tissue regeneration and pain management, their effectiveness for shoulder OA remains under investigation.
- PRP Injections: Some of my patients who have tried PRP report reduced pain and improved function, although results can be inconsistent. PRP works by introducing growth factors that promote tissue healing.
- Bone Marrow Aspirate Concentrate (BMAC) & Stem Cells: These treatments aim to regenerate cartilage and reduce inflammation. While they have shown success in knee OA, more studies are needed for their use in shoulder OA.
Hyaluronic Acid Injections
I have also seen some patients try hyaluronic acid injections to improve joint lubrication. While some report temporary relief, clinical studies remain inconclusive about their long-term benefits compared to corticosteroid injections.
Managing Shoulder OA in Athletes
Athletes present a unique challenge when it comes to OA management. A significant number of my patients hesitate to adjust their routines, but I stress the necessity of finding a balance between maintaining fitness and safeguarding joint health. I frequently advise:
- Modifying activities to reduce repetitive overhead movements and minimize joint strain.
- Incorporating strength training to improve shoulder stability and support overall function.
- Following a structured physical therapy plan to maintain mobility while preventing symptom flare-ups.
While corticosteroid injections can provide temporary relief, I advise using them with caution, as overuse may lead to adverse effects. Additionally, complete immobilization is generally discouraged, as it can increase stiffness and weaken the surrounding muscles, making movement more challenging over time.
Conclusion
Through my experience as a physical therapist, I have found that a multifaceted approach to glenohumeral OA is the most effective. A well-rounded treatment plan that includes physical therapy, medications, and biological therapies can help maintain shoulder function and delay surgery. Patients who adhere to their care plan tend to have better outcomes and can continue their daily activities with minimal disruption.
*Journal Reference: Nobuyuki Yamamoto, Dominik Szymski, Andreas Voss, Hiroaki Ishikawa, Takayuki Muraki, Ronaldo A. Cunha, Benno Ejnisman, Joseph Noack, Eric McCarty, Mary K. Mulcahey, Eiji Itoi, Non-operative management of shoulder osteoarthritis: Current concepts Journal of ISAKOS, Volume 8, Issue 5, 289 - 295