Physical Therapist Management of Glenohumeral Joint Osteoarthritis: A Clinical Practice Guideline from the American Physical Therapy Association.
Lori A Michener, Jill Heitzman, Laurel D Abbruzzese and 7 others
PMID 37115808WHAT IT FOUND
For patients after shoulder replacement, starting motion exercises immediately versus waiting four weeks made no difference in long-term function or pain.
A neutral-position sling reduced night pain early on, but the choice of specific exercises remains based on clinical judgment due to limited evidence.
Key findings
01Delaying shoulder range-of-motion exercises for up to four weeks after total shoulder arthroplasty does not negatively impact patient-reported outcomes at one year.
02Using a sling that holds the shoulder in neutral rotation reduces night pain at two weeks post-surgery compared to a traditional internal rotation sling, though long-term differences are not statistically significant.
03There is insufficient evidence to recommend one specific physical therapist intervention over another for non-operative glenohumeral osteoarthritis, so treatment should be guided by clinical expertise and patient values.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Evidence for many common practices, such as preoperative therapy and specific nonoperative interventions, is insufficient, relying on expert opinion rather than high-quality trials. The guideline excludes reverse total shoulder arthroplasty and revision surgeries, so findings do not apply to those patient groups. Studies on postoperative timing and sling position had small sample sizes (n=60 and n=36 respectively) and short follow-up periods for some outcomes. The search was limited to English-language publications from 1990 to 2020.
Declared interests
The American Physical Therapy Association (APTA) funded the work and coordinated the guideline development. The APTA stated it played no role in the design, conduct, or reporting of the recommendations. The guideline was developed with paid consultants from the American Academy of Orthopaedic Surgeons (AAOS).
The easy way to misread this
Do not assume that immediate postoperative exercise is superior for long-term function. The evidence shows no significant difference in outcomes at one year between immediate and delayed motion, and delaying may allow better healing of the subscapularis or osteotomy site.